Journal of Global Infectious Diseases最新文献

Introduction: Helicobacter pylori-induced chronic infection is associated with peptic ulcer, chronic gastritis, gastric cancer, and increasing antibiotic resistance. We aimed to evaluate the efficacy of clarithromycin-based triple therapy and non-bismuth based quadruple therapy for eradicating H. pylori in patients with chronic gastritis in Kuwait.

Methods: We enrolled a total of 603 treatment-naive dyspeptic patients with gastric biopsy-proven chronic gastritis secondary to H. pylori in a prospective, open-label, randomized study. Patients were randomized into two groups: a group received the standard triple therapy (omeprazole, amoxicillin, and clarithromycin) for 14 days and a group received quadruple therapy (omeprazole, amoxicillin, clarithromycin, and metronidazole) for 14 days. All patients were tested for the eradication of H. pylori by carbon-13 urea breath test 1 month after eradication therapy.

Results: The overall eradication rate was 63.2%. The eradication rates in intention-to-treat (ITT) and per protocol (PP) population were 58.4% and 64.6%, respectively, in triple therapy group. In the quadruple therapy group, the eradication rates in ITT and PP population were 68.0% and 78.5%, respectively, with a statistically significant higher eradication rate in patients treated by quadruple therapy than the triple therapy (P < 0.01). Multivariate logistic regression analysis revealed that treatment regimen was the only significant predictor for successful H. pylori eradication. The most common adverse events were abnormal taste, headache, dizziness, and abdominal pain.

Conclusion: Non-bismuth based quadruple therapy is more effective than standard clarithromycin-based triple therapy for eradicating H. pylori in patients with chronic gastritis.ClinicalTrials.gov Identifier: NCT04617613.

Introduction: Co-infection with different agents such as bacterial, viral, and Rickettsia is being increasingly recognized due to greater availability and utilization of the diagnostic tests among malaria patients.

Methods: Consecutive admitted malarial cases were included and were subjected to test for general investigations, bacteria, typhoid, dengue, chikungunya, and rest for specific diagnosis. All patients were followed up till discharge or death and appropriate statistical tests were performed.

Results: A total of 152 malaria patients were recruited and 27 (18.8%) had concurrent infections. It included 40.7% dengue only, 18.7% pneumonia, 11.1% urinary tract infection (UTI), 7.4% enteric fever, 3.7% leptospirosis, chikungunya, and tuberculous meningitis each, and 3.7% each of dengue with pneumonia and UTI. The organisms isolated were Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, Salmonella typhi, and Mycobacterium tuberculosis. The mean duration of fever was 6.33 ± 3.63 days with a range of 3-20 days. Blood culture grew in 2 cases S. typhi and K. pneumonia,e. Dengue co-infections had significantly higher clinical and laboratory features of dengue and complications such as bleeding, jaundice, and cholecystitis, whereas rest concurrent infections had a significantly higher proportion of nausea and vomiting, convulsion, altered sensorium, productive cough, urinary symptoms, shock, acute kidney injury, anemia, and mean neutrophil count. There was significantly higher mortality among malaria-dengue concurrent infection group with 2 (15.4%) than malaria mono-infection group 3 (2.4%).

Conclusion: Co-infections with malaria are not uncommon, especially dengue fever and other bacterial infections. The dominant clinical picture is of the superimposed infection. Decision should be clinically guided adjunct with specific diagnostic tests, and timely treatment has favorable outcome.

Introduction: Infections associated with catheter in the upper urinary tract (CUUT), which include the double-J stent and the percutaneous nephrostomy (PCN) tube, get particularly infected in patients with specific risk factors for developing an infection.

Methods: A retrospective observational study was carried out by compiling data from the hospital information system of a tertiary care center from 2019 to 2021 to evaluate infections in patients with catheter in the upper urinary tract.

Result: A total of 200 pus samples of double-J stent (96 pus samples) and PCN tube (104 pus samples) were included in our study. Among patients with nephrostomy tube, the most frequently isolated microorganisms were Escherichia coli, followed by Pseudomonas spp. In those with a double-J stent, Pseudomonas aeruginosa, followed by E. coli were the most commonly isolated microorganisms. We found 55.72% of cases of Enterobacteriaceae-producing carbapenemases in patients with a percutaneous catheter. 66.07% of Enterobacteriaceae in patients with double-J and nephrostomy stents are extended-spectrum beta-lactamase-producing bacteria. The percentage of cultures with multiple-drug resistance (MDR) microorganisms was 38.54% in patients with double-J stents and 37.75% in nephrostomy tubes. The presence of prior urinary tract infection (P = 0.010), presence of urinary catheter before admission (P = 0.005), increased time with single urinary catheter in-situ (P < 0.001), and increased length of hospital stay (P = 0.036) were risk factors for isolation of MDR microorganisms.

Conclusion: Pseudomonas spp. and Pseudomonas aeruginosa are commonly infecting both the CUUT. E. coli infections are more commonly infecting the nephrostomy tubes. MDR microorganisms are frequent, mainly in patients with prior urinary tract infection, presence of urinary catheter before admission, and prolonged use of a single catheter.

Coronavirus disease 2019 (COVID-19) has been reported in association with a variety of brain imaging findings such as acute hemorrhagic necrotizing encephalopathy. To the best of our knowledge, we are reporting a second case of acute necrotizing hemorrhagic encephalopathy associated with COVID-19, which was fatal in a few hours in a 56-year-old male without a specific history. We claim that this case is important because this case shows that the unconscious patients are potentially infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and might cause the horizontal infection. In order to end the pandemic of SARS-CoV-2 diseases, the diagnosis of the disease must be prompt and not overlook any findings. We think that diffusion magnetic resonance imaging is a promising and useful sequence to evaluate the changes in brain tissue in the acute necrotizing encephalopathy.

Introduction: Ivermectin, hydroxychloroquine (HQ), and darunavir/ritonavir are widely prescribed as an oral treatment for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection despite their uncertainty of clinical benefit. The objective is to determine the safety and the efficacies of two treatment regimens against SARS-CoV-2 infection.

Methods: We conducted an open-labeled, randomized, controlled trial to compare the efficacy between a 3-day course of once-daily high-dose oral ivermectin plus zinc sulfate (Group A) and a combination of HQ, darunavir/ritonavir, and zinc sulfate (HQ + antiretroviral, Group B) for 5 days in asymptomatic or mild SARS-CoV-2 infection. The study period was between December 2020 and April 2021.

Results: Overall, 113 patients were randomized and analyzed (57 patients in Group A and 56 patients in Group B). The median duration to achieve the virological outcome of either undetected or cycle threshold (Ct) for N gene of SARS-CoV-2 by real-time polymerase chain reaction was 6 days (95% confidence interval [CI] 5.3-6.7) versus 7 days (95% CI: 5.4-8.6) in Group A and Group B, respectively (P = 0.419) in the modified intention-to-treat population. All patients were discharged from hospital quarantine as planned. Two patients in Group A and one patient in Group B were considered clinically worsening and received 10 days of favipiravir treatment. There was no serious adverse event found in both groups.

Conclusion: We demonstrated that both treatment regimens were safe, but both treatment regimens had no virological or clinical benefit. Based on this result and current data, there is no supporting evidence for the clinical benefit of ivermectin for coronavirus-19.

Introduction: Bartonella quintana is an anaerobic bacillus whose main target is the erythrocyte. This bacterium transmitted by the body louse notably infected the soldiers of the First World War from where the name of this disease: fever of the trenches. The 90s marked the return of this bacterial infection. B. quintana infection in the homeless was reported in the literature with a high incidence in these populations worldwide. This upsurge of cases justified this study for a better understanding of B. quintana infections.

Methods: We conducted a systematic review to evaluate the seroprevalence of B. quintana infection by using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to collect scientific papers from PubMed and Google Scholar based on combining keywords.

Results: The review included 45 articles published from April 1996 to March 2020 with 84 subpopulations of 21 countries from 4 continents; among them, 61 subpopulations had a positive rate from 0.2% to 65%. These subpopulations were divided into four main groups: homeless people, healthy people, blood donors, and symptoms/diseases. Homeless people were the main target of this infection, and three factors related to susceptibility were homeless period, age, and alcoholism. 6/11, 12/20, and 32/41 subpopulations of healthy people, blood donors, symptoms/diseases, respectively, had a positive percentage. However, factors of exposure in these three groups were not mentioned. Other reservoirs, vectors, and transmitted routes were identified to partially explain the worldwide spread of the infection, and it is important to have more further investigations to identify potential risk factors. This will help to limit contamination and prevent effectively.

Conclusions: This serological overview indicated the importance of B. quintana infection that has emerged in multiple regions, touched worldwide populations.

Introduction: Hyponatremia is a frequent finding in hospitalized patients and is associated with poor clinical outcomes. While hyponatremia is known to commonly occur in certain infections, its association with melioidosis has not been studied previously. We studied incidence and impact of hyponatremia on clinical outcomes in melioidosis.

Methods: This was a retrospective analysis of a single-center hospital registry of culture-positive patients with melioidosis hospitalized during a 10-year period (January 01, 2010, through January 31, 2021). Hyponatremia was defined as serum sodium of <135 mmol/L, and severe hyponatremia as serum sodium <120 mmol/L. The association of hyponatremia with in-hospital mortality, need for intensive care unit (ICU) stay and mechanical ventilation was studied.

Results: Of 201 patients with melioidosis, 169 (84.1%) had hyponatremia, with severe hyponatremia in 35 (17.4%) patients. Older age (adjusted odds ratios [OR] 1.03, 95% confidence intervals [CI]: 1.00-1.06; P = 0.049) and acute kidney injury (AKI) (adjusted OR 3.30, 95% CI: 1.19-9.19; P = 0.02) were independently associated with hyponatremia. Twenty-two patients had been evaluated for cause of hyponatremia and of these, 11 (50%) had syndrome of inappropriate antidiuresis. Severe hyponatremia was associated with in-hospital mortality (adjusted OR 3.75, 95% CI: 1.37-10.27; P = 0.01), need for ICU stay (adjusted OR 7.04, 95% CI: 2.88-17.19; P < 0.001) and mechanical ventilation (adjusted OR 3.99, 95% CI: 1.54-10.32; P = 0.004).

Conclusion: Hyponatremia occurs in 84.1% of hospitalized patients with melioidosis. Older age and AKI are associated with a higher incidence of hyponatremia. The presence of severe hyponatremia is an independent predictor of in-hospital mortality, need for mechanical ventilation and ICU stay.