Infection and Chemotherapy最新文献

Cytomegalovirus (CMV) is a significant concern for patients with allogeneic hematopoietic cell transplantation (allo-HCT). CMV management differs between institutions due to the lack of local guidelines. Here, we describe a case of refractory/resistant CMV infection treated using our institution's CMV management protocol. A 59-year-old woman who underwent allo-HCT was treated for CMV reactivation. Despite 3 months of valganciclovir administration, serum CMV level surged. CMV gene mutation test revealed a ganciclovir-resistant A594V mutation in the UL97 gene. Treatment was switched to foscarnet until the drug became unavailable nationwide. During the foscarnet shortage, cidofovir was used, leading to a decline in CMV levels when foscarnet was reintroduced and used for 2 months. Following allo-HCT, CMV prophylaxis with letermovir is crucial to prevent reactivation in seropositive recipients. CMV titers should be monitored frequently after allo-HCT. The cutoff value for preemptive therapy varies across institutions, with ganciclovir/valganciclovir usually administered as first-line therapy. Maribavir is an option in cases of ganciclovir/valganciclovir resistance or intolerance. CMV gene mutations should be examined in patients with suspected resistance after 2 weeks of appropriate treatment. This case was discussed at the Clinical Grand Round of the Annual Conference of the Korean Society of Infectious Diseases on November 2, 2023.

Background: The global resurgence of mpox, formerly monkeypox, poses an emerging threat to pregnant women due to immunological changes and potential vertical transmission, yet its impact on pregnancy remains underexplored. This study aims to pioneer a comprehensive assessment of pregnancy outcomes and the risks of vertical transmission associated with mpox infection during pregnancy.

Materials and methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched three databases up to September 2024 for studies on pregnant women with mpox confirmed by quantitative polymerase chain reaction. Primary outcomes were composite adverse pregnancy outcomes: miscarriage or fetal death, congenital anomalies, and chorioamnionitis; the secondary outcome was vertical transmission. Study quality was assessed using Joanna Briggs Institute tools. Statistical analysis employed R software using a one-proportion model with Freeman-Tukey transformation and random-effects meta-analysis (restricted maximum-likelihood estimator, Knapp-Hartung adjustment), presenting estimated proportions with 95% confidence intervals (CIs).

Results: Six studies (three case series, three case reports) comprising 11 singleton pregnancies were included. Diagnoses occurred in the first (27.3%), second (45.4%), and third trimesters (27.3%). Among the five genotypically identified Mpox cases, 20.0% were classified Clade I and 80.0% as Clade II. Meta-analysis indicated that an estimated 63% (95% CI, 43-83%) of pregnancies experienced composite adverse pregnancy outcomes. Specifically, miscarriage or fetal death occurred in 62% (95% CI, 21-102%), congenital anomalies in 50% (95% CI, 21-80%), and chorioamnionitis in 78% (95% CI, 44-96%). Vertical transmission was observed in 79% (95% CI, 6-151%). Despite small sample sizes leading to wide confidence intervals, high estimated proportions suggest that mpox severely impacts pregnancy outcomes, likely linked to maternal inflammation, placental invasion, and significant fetal risks from vertical transmission.

Conclusion: Mpox infection during pregnancy appears to be associated with high rates of adverse pregnancy outcomes and vertical transmission. Further large-scale studies are warranted to confirm these findings and develop preventive and management strategies mitigating this emerging threat.

Background: Antimicrobial resistance has emerged as a global public health challenge, leading to higher mortality rates from infections that were once treatable with antibiotics. In this study, we assessed the susceptibility of Escherichia coli strains isolated from clinical samples to carbapenems and fluoroquinolones and screened for genetic determinants mediating resistance.

Materials and methods: This retrospective study included 46 E. coli isolates retrieved from the stock culture collection at the Molecular Biology and Biotechnology Department of the Nigerian Institute of Medical Research. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method, and molecular techniques were employed to detect genetic determinants of antimicrobial resistance.

Results: The E. coli isolates exhibited high resistance to fluoroquinolones, with 72% resistant to ciprofloxacin and 52% to levofloxacin. Resistance to carbapenems was relatively low, with 4% resistant to imipenem and 11% to meropenem. The prevalence of the genetic determinants gyrA, gyrB, and parC, which mediate fluoroquinolone resistance, was 26%, 24%, and 15%, respectively. bla_OXA-48 and bla_NDM, which mediate carbapenem resistance, were detected in only two isolates. Some isolates harbored plasmids ranging from 5 kb to 16 kb; however, no plasmid-mediated genetic determinants conferring fluoroquinolone resistance were identified.

Conclusion: This study revealed a high level of resistance to fluoroquinolones, emphasizing the need for judicious use of antibiotics, particularly those with low resistance rates. Continuous surveillance is essential to monitor emerging trends in resistance among bacterial pathogens.

We report a case of cytomegalovirus retinitis in a hematopoietic stem cell transplant recipient during valganciclovir pre-emptive therapy followed by maribavir. Analysis of UL97 mutation revealed a C480F substitution associated with high maribavir resistance and low ganciclovir resistance.

Background: In patients with aplastic anemia (AA), infection-related complications are the leading cause of mortality. However, limited knowledge about the predictive factors for infection in these patients exists. Thus, this study aimed to evaluate risk factors for infection and develop a risk prediction model for the occurrence of infection in patients with AA.

Materials and methods: Between January 2004 and December 2020, 206 patients with AA ≥15 years of age were included in this study. Survival analysis using recurrent event methodologies was conducted to identify predictive factors associated with infection, including the Anderson and Gill model; Prentice, Williams, and Peterson (PWP) Total Time model; PWP Gap Time model; marginal model; and frailty models. The best model was determined using backward stepwise regression, and internal validation was performed using the bootstrapping method with 500 re-samplings.

Results: With a median follow-up of 2.95 years, the incidence rate of infection among patients with AA was 32.8 events per 100 person-years. The PWP Total Time model revealed that cirrhosis comorbidity, lymphocytes ≥80%, and previous infection increased the risk of infection, while bone marrow cellularity ≥20% offered protection. The bone marrow cellularity, lymphocyte percentage, previous infection, cirrhosis, and hematocrit (BLICH) model was generated to predict the risk of infection. The internal validation showed a good calibration of this model.

Conclusion: Cirrhosis, lymphocytes ≥80%, previous infection, and bone marrow cellularity <20% are risk factors for infection in patients with AA. The BLICH model can predict the risk of infection in these patients.

Since its Fast-Track approval by the Federal Drug Administration, the human papillomavirus (HPV) vaccine has been marked by controversies. Unconfirmed reports of adverse events in both Japan and Denmark led to suspensions of national vaccination programs, which setback the fight against cervical cancer and associated mortality and morbidity. Despite follow-up studies of vaccine adverse reports, additional randomized control trials, and review reports from both the World Health Organization and the European Commission, there is still a great deal of hesitancy around the vaccine. While all three version of the HPV vaccine have been shown to be efficacious and safe, additional ethical dilemmas deserve to be considered as well.