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The persistence of low CD4/CD8 ratio in chronic HIV-infection, despite ART suppression and normal CD4 levels, is associated with pre-therapy values of inflammation and thymic function. 尽管抗逆转录病毒疗法(ART)得到了抑制且 CD4 水平正常,但慢性 HIV 感染者的 CD4/CD8 比值持续偏低,这与治疗前的炎症值和胸腺功能有关。
IF 4.5 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-22 DOI: 10.1016/j.jmii.2024.08.007
Vanesa Garrido-Rodríguez, Ángel Bulnes-Ramos, Israel Olivas-Martínez, María Del Mar Pozo-Balado, Ana Isabel Álvarez-Ríos, Félix Gutiérrez, Rebeca Izquierdo, Federico García, Juan Manuel Tiraboschi, Francisco Vera-Méndez, Joaquim Peraire, Anna Rull, Yolanda María Pacheco

Background: Persistence of a low CD4/CD8 ratio is associated with an increased morbimortality in people living with HIV (PLWH) under effective antiretroviral therapy. We aimed to explore the immunological significance of a persistently low CD4/CD8 ratio, even despite normal CD4 levels, and assess whether these features vary from those associated to a low nadir-CD4, another well-established predictor of disease progression.

Methods: CD4-recovered PLWH were classified by CD4/CD8 ratio after three-years of ART (viral suppression, CD4≥500; R < 0.8, n = 24 and R > 1.2, n = 28). sj/β-TRECs ratio and inflammatory-related markers were quantified. PBMCs were immunophenotyped by CyTOF and functionally characterized by ELISPOT. Subjects were also reclassified depending on nadir-CD4 (N ≤ 350/N > 350).

Results: R < 0.8 showed a differential inflammatory profile compared to R > 1.2 (increased β2-microglobulin, D-dimers and IP-10 before ART). R < 0.8 presented lower baseline thymic function, being inversely correlated with post-ART inflammation. R < 0.8 at follow-up showed most alterations in CD8 subsets (increasing frequency and exhibiting a senescent phenotype [e.g., CD57+, CD95+]) and enhanced T-cell IFNγ/IL-2 secretion. However, comparing N ≤ 350 to N > 350, the main features were altered functional markers in CD4 T-cells, despite no differences in maturational subsets, together with a restricted T-cell cytokine secretion pattern.

Conclusion: Persistence of low CD4/CD8 ratio in successfully-treated PLWH, with normal CD4 counts, is associated with baseline inflammation and low thymic function, and it features post-therapy alterations specific to CD8 T-cells. Differently, subjects recovered from low nadir-CD4 in this setting feature post-therapy alterations on CD4 T-cells. Hence, different mechanisms of disease progression could underlie these biomarkers, potentially requiring different clinical approaches.

背景:在接受有效抗逆转录病毒治疗的艾滋病病毒感染者(PLWH)中,CD4/CD8比值持续偏低与死亡率增加有关。我们的目的是探索 CD4/CD8 比值持续偏低(即使 CD4 水平正常)的免疫学意义,并评估这些特征是否与另一个成熟的疾病进展预测指标--低 nadir-CD4 相关特征有所不同:方法:对经过三年抗逆转录病毒疗法(病毒抑制,CD4≥500;R 1.2,n = 28)的 CD4 恢复的 PLWH 按 CD4/CD8 比率进行分类。用 CyTOF 对白细胞介导细胞进行免疫分型,并用 ELISPOT 对其进行功能定性。还根据 nadir-CD4 对受试者进行了重新分类(N ≤ 350/N > 350):R 1.2(抗逆转录病毒疗法前,β2-微球蛋白、D-二聚体和 IP-10 增高)。结果:R 1.2(抗逆转录病毒疗法前,β2-微球蛋白、D-二聚体和 IP-10 增高);R 350,主要特征是 CD4 T 细胞功能标志物发生变化,尽管成熟亚群没有差异,同时 T 细胞细胞因子分泌模式受到限制:结论:CD4 细胞计数正常但治疗成功的 PLWH 患者的 CD4/CD8 细胞比率持续偏低与基线炎症和胸腺功能低下有关,其特点是 CD8 T 细胞在治疗后发生特异性改变。与此不同的是,在这种情况下,从低 nadir-CD4 恢复的受试者的 CD4 T 细胞在治疗后会发生改变。因此,不同的疾病进展机制可能是这些生物标志物的基础,可能需要不同的临床方法。
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引用次数: 0
The clinical impact of primary granulocyte-colony stimulating factor prophylaxis in children with acute lymphoblastic leukemia who underwent induction chemotherapy. 对接受诱导化疗的急性淋巴细胞白血病患儿进行初级粒细胞集落刺激因子预防的临床影响。
IF 4.5 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-20 DOI: 10.1016/j.jmii.2024.08.004
Yi-An Lu, Hsi-Che Liu, Jen-Yin Hou, Nan-Chang Chiu, Ting-Huan Huang, Ting-Chi Yeh

Background: Data describing the risk factors for the occurrence of severe infections in acute lymphoblastic leukemia (ALL) patients following induction chemotherapy and the role of prophylactic granulocyte-colony stimulating factor (G-CSF) in the era of antimicrobials prophylaxis are limited.

Methods: This study enrolled 188 children aged ≤18 years with newly diagnosed ALL who received Taiwan Pediatric Oncology Group ALL-2002 and 2013 treatments between January 1, 2010 and June 30, 2021. Prophylactic G-CSF was administered when a patient continues neutropenia after achieving the first bone marrow remission since June 1, 2015. Clinical factors were assessed for their association with severe infections.

Results: From January 2010 to May 2015, 80 children experienced a total of 11 (13.5%) episodes of severe infections; while 10 (9.2%) episodes were reported to occur in 108 patients who received prophylactic G-CSF. Reduction of severe infections occurrence did not achieve statistical significance during prophylactic G-CSF administration in ALL patients. Compared with ALL-high risk (HR) and very high risk patients with no G-CSF prophylaxis, the use of G-CSF prophylaxis significantly reduced episodes of febrile neutropenia. Occurrence of grade III-IV intestinal ileus, grade II-III oral mucositis, prolonged neutropenia, central venous catheter (CVC) placement, or the requirement insulin therapy for hyperglycemia were associated with higher risk of bloodstream infections.

Conclusions: ALL-HR patients with G-CSF prophylaxis were associated with reduction of febrile neutropenia episodes. Occurrence of severe ileus, oral mucositis, hyperglycemia, CVC placement, or prolonged neutropenia were associated with severe infections in ALL patients receiving induction chemotherapy.

背景:描述急性淋巴细胞白血病(ALL)患者在诱导化疗后发生严重感染的风险因素以及预防性粒细胞集落刺激因子(G-CSF)在抗菌药物预防时代的作用的数据十分有限:本研究招募了188名年龄小于18岁的新确诊ALL患儿,他们在2010年1月1日至2021年6月30日期间接受了台湾儿科肿瘤学组ALL-2002和2013治疗。自2015年6月1日以来,患者在获得首次骨髓缓解后,如果继续出现中性粒细胞减少症,则会使用预防性G-CSF。对临床因素与严重感染的关系进行了评估:从2010年1月到2015年5月,80名儿童共发生了11次(13.5%)严重感染;而在108名接受预防性G-CSF的患者中,据报告发生了10次(9.2%)严重感染。在ALL患者预防性使用G-CSF期间,严重感染发生率的降低并没有统计学意义。与未使用 G-CSF 预防性治疗的 ALL 高危(HR)和极高危患者相比,使用 G-CSF 预防性治疗可显著减少发热性中性粒细胞减少症的发生。发生III-IV级肠回肠炎、II-III级口腔粘膜炎、中性粒细胞减少时间延长、中心静脉导管(CVC)置入或因高血糖需要胰岛素治疗与较高的血流感染风险有关:结论:ALL-HR患者接受G-CSF预防治疗可减少发热性中性粒细胞减少症的发生。在接受诱导化疗的ALL患者中,出现严重回肠炎、口腔黏膜炎、高血糖、CVC置入或中性粒细胞减少时间延长与严重感染有关。
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引用次数: 0
Predictors of liver fibrosis changes assessed by paired liver biopsies in chronic hepatitis C patients treated with direct-acting antivirals. 通过配对肝活检评估接受直接作用抗病毒药物治疗的慢性丙型肝炎患者肝纤维化变化的预测因素。
IF 4.5 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-14 DOI: 10.1016/j.jmii.2024.08.005
Ming-Han Hsieh, Tzu-Yu Kao, Ting-Hui Hsieh, Chun-Chi Kao, Cheng-Yuan Peng, Hsueh-Chou Lai, Hsing-Hung Cheng, Mao-Wang Ho, Chih-Yu Chi, Jung-Ta Kao

Background/purpose: There are limited studies performing paired liver biopsies in chronic hepatitis C (CHC) patients treated with direct-acting antivirals (DAA). We aimed to investigate the predictors of liver fibrosis changes assessed by paired liver biopsies in these patients.

Methods: From March 2017 to March 2020, 113 CHC patients were prospectively enrolled to receive DAA therapy at our hospital. Paired liver biopsies were performed at baseline and 12 weeks after the end of treatment.

Results: Among the entire cohort, the rate of sustained virological response (SVR) was 100%. Four baseline variables independently predicted fibrosis regression, including age <65 years [odds ratio (OR) = 2.725, p = 0.036], fibrosis stages (METAVIR scores) < 3 (OR = 4.874, p = 0.040), hemoglobin levels ≥12.5 g/dL (OR = 3.538, p = 0.029), and platelet counts ≥160 103/μL (OR = 2.958, p = 0.023). Besides, five independent predictors of fibrosis progression included baseline age ≥66 years (OR = 16.351, p = 0.024), body mass index (BMI) ≥26.5 kg/m2 (OR = 21.666, p = 0.009), sofosbuvir/ribavirin use (OR = 29.465, p = 0.031), platelet counts <119 103/μL (OR = 33.739, p = 0.026), and the absence of alanine aminotransferase (ALT) levels declining from >35 U/L at baseline to ≤35 U/L at 4 weeks after baseline (OR = 284.534, p = 0.026).

Conclusion: For DAA-treated CHC patients, those with baseline age <65 years, fibrosis stages <3, hemoglobin levels ≥12.5 g/dL, or platelet counts ≥160 103/μL are more likely to attain fibrosis regression. There is a higher risk of fibrosis progression in those with baseline age ≥66 years, BMI ≥26.5 kg/m2, sofosbuvir/ribavirin use, platelet counts <119 103/μL, or the absence of early ALT normalization at 4 weeks after baseline.

背景/目的:对接受直接作用抗病毒药物(DAA)治疗的慢性丙型肝炎(CHC)患者进行配对肝活检的研究非常有限。我们旨在研究通过配对肝活检评估这些患者肝纤维化变化的预测因素:2017年3月至2020年3月,我院前瞻性招募了113名CHC患者接受DAA治疗。在基线和治疗结束后12周进行配对肝活检:结果:在整个队列中,持续病毒学应答(SVR)率为100%。四个基线变量可独立预测纤维化回归,包括年龄 3/μL(OR = 2.958,p = 0.023)。此外,5个独立的纤维化进展预测因子包括基线年龄≥66岁(OR = 16.351,P = 0.024)、体重指数(BMI)≥26.5 kg/m2(OR = 21.666,P = 0.009)、使用索非布韦/利巴韦林(OR = 29.465,P = 0.031)、血小板计数3/μL(OR = 33.739,P = 0.026)、丙氨酸氨基转移酶(ALT)水平未从基线时的>35 U/L下降至基线后4周时的≤35 U/L(OR = 284.534,P = 0.026):结论:对于接受DAA治疗的CHC患者,基线年龄为3/μL的患者更有可能实现纤维化消退。基线年龄≥66岁、体重指数≥26.5 kg/m2、使用索非布韦/利巴韦林、血小板计数为3/μL或基线后4周ALT未恢复正常的患者发生纤维化进展的风险更高。
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引用次数: 0
Unveiling the dynamics of respiratory infections revealed by multiplex PCR testing during the COVID-19 pandemic in Taiwan, 2020-2023. 通过多重 PCR 检测揭示 2020-2023 年台湾 COVID-19 大流行期间呼吸道感染的动态。
IF 4.5 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-12 DOI: 10.1016/j.jmii.2024.08.003
Hung-Chieh Su, Yu-Chang Chang, Chih-Hao Chen, Meng-Yu Cheng, Wen-Hsin Hsih, Yi-Jhen Chen, Chia-Huei Chou, Yu-Chao Lin, Chiung-Tzu Hsiao, Hong-Mo Shih, Mao-Wang Ho, Po-Ren Hsueh

Background: The emergence of SARS-CoV-2 in late 2019 sparked the global COVID-19 pandemic, leading to varied vaccine policies worldwide. The evolving patterns of respiratory pathogens, aside from SARS-CoV-2, during the pandemic have had a significant impact on the development of vaccine strategies.

Methods: This study explores the landscape of respiratory pathogens, encompassing SARS-CoV-2, respiratory syncytial virus (RSV), and influenza viruses, through a retrospective analysis of data obtained from the BioFire Respiratory Panel 2.1 (RP 2.1) at China Medical University Hospital (Taichung, Taiwan) spanning from January 2020 to November 2023.

Results: Among the 7950 respiratory samples studied, pediatric cases exhibited higher positivity (64.9%, 2488/3835) and mixed detection rates (43.8%, 1090/2488) than adults. Annual mixed detection rates increased (27.9-48%). Prevalence analysis revealed diverse patterns across age groups, with higher rates in pediatrics. Notably, human rhinovirus/enterovirus predominated (48.1%). Mixed detection illustrated viral co-detections, notably with parainfluenza viruses and adenovirus. Government policies and pandemic dynamics influenced infection patterns, with RSV resurgence after May 2022. Age-specific RSV detection demonstrated a shift, influencing vaccine considerations. Amid global vaccine initiatives, RSV's increasing trend in adults warrants attention.

Conclusions: This comprehensive analysis emphasizes the importance of multiplex PCR testing in shaping targeted vaccination strategies during evolving respiratory pathogen landscapes.

背景:2019年末,SARS-CoV-2的出现引发了全球COVID-19大流行,导致全球范围内的疫苗政策各不相同。除SARS-CoV-2外,大流行期间呼吸道病原体的演变模式对疫苗策略的制定产生了重大影响:本研究通过回顾性分析中国医药大学附属医院(台湾台中)BioFire Respiratory Panel 2.1(RP 2.1)从 2020 年 1 月至 2023 年 11 月期间获得的数据,探讨了包括 SARS-CoV-2、呼吸道合胞病毒(RSV)和流感病毒在内的呼吸道病原体的格局:在研究的 7950 份呼吸道样本中,儿科病例的阳性率(64.9%,2488/3835)和混合检出率(43.8%,1090/2488)均高于成人。年混合检出率有所上升(27.9%-48%)。流行率分析揭示了各年龄组的不同模式,其中儿科的流行率较高。值得注意的是,人类鼻病毒/肠道病毒占主导地位(48.1%)。混合检测表明存在病毒混合检测,特别是副流感病毒和腺病毒。政府政策和大流行动态影响了感染模式,2022 年 5 月后 RSV 再次流行。年龄特异性 RSV 检测显示出了变化,影响了疫苗接种的考虑因素。在全球疫苗计划中,RSV 在成人中的增长趋势值得关注:这项综合分析强调了多重 PCR 检测在不断变化的呼吸道病原体环境中制定有针对性的疫苗接种策略的重要性。
{"title":"Unveiling the dynamics of respiratory infections revealed by multiplex PCR testing during the COVID-19 pandemic in Taiwan, 2020-2023.","authors":"Hung-Chieh Su, Yu-Chang Chang, Chih-Hao Chen, Meng-Yu Cheng, Wen-Hsin Hsih, Yi-Jhen Chen, Chia-Huei Chou, Yu-Chao Lin, Chiung-Tzu Hsiao, Hong-Mo Shih, Mao-Wang Ho, Po-Ren Hsueh","doi":"10.1016/j.jmii.2024.08.003","DOIUrl":"https://doi.org/10.1016/j.jmii.2024.08.003","url":null,"abstract":"<p><strong>Background: </strong>The emergence of SARS-CoV-2 in late 2019 sparked the global COVID-19 pandemic, leading to varied vaccine policies worldwide. The evolving patterns of respiratory pathogens, aside from SARS-CoV-2, during the pandemic have had a significant impact on the development of vaccine strategies.</p><p><strong>Methods: </strong>This study explores the landscape of respiratory pathogens, encompassing SARS-CoV-2, respiratory syncytial virus (RSV), and influenza viruses, through a retrospective analysis of data obtained from the BioFire Respiratory Panel 2.1 (RP 2.1) at China Medical University Hospital (Taichung, Taiwan) spanning from January 2020 to November 2023.</p><p><strong>Results: </strong>Among the 7950 respiratory samples studied, pediatric cases exhibited higher positivity (64.9%, 2488/3835) and mixed detection rates (43.8%, 1090/2488) than adults. Annual mixed detection rates increased (27.9-48%). Prevalence analysis revealed diverse patterns across age groups, with higher rates in pediatrics. Notably, human rhinovirus/enterovirus predominated (48.1%). Mixed detection illustrated viral co-detections, notably with parainfluenza viruses and adenovirus. Government policies and pandemic dynamics influenced infection patterns, with RSV resurgence after May 2022. Age-specific RSV detection demonstrated a shift, influencing vaccine considerations. Amid global vaccine initiatives, RSV's increasing trend in adults warrants attention.</p><p><strong>Conclusions: </strong>This comprehensive analysis emphasizes the importance of multiplex PCR testing in shaping targeted vaccination strategies during evolving respiratory pathogen landscapes.</p>","PeriodicalId":56117,"journal":{"name":"Journal of Microbiology Immunology and Infection","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clofazimine and QT prolongation in the treatment of rifampicin-resistant tuberculosis: Findings of aDSM in Taiwan 治疗耐利福平结核病时氯苯胍与 QT 间期延长:台湾 aDSM 的研究结果。
IF 4.5 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-08 DOI: 10.1016/j.jmii.2024.08.002
Chou-Jui Lin , Jin-Hua Chen , Shun-Tien Chien , Yi-Wen Huang , Chih-Bin Lin , Jen-Jyh Lee , Chih-Hsin Lee , Ming-Chih Yu , Chen-Yuan Chiang

Background

Bedaquiline, delamanid and fluoroquinolones are associated with increased QTcF. Whether clofazimine is associated with QTcF prolongation is less clear.

Methods

All patients with rifampicin-resistant TB enrolled between May 2017 and Dec 2019 were included. ECGs were performed at baseline, month 1, month 3 and month 6 for patients treated with conventional regimens, and at additional timepoint for patients treated with bedaquiline, delamanid and short regimen. We estimated the maximum increase of QTcF and constructed cox proportional hazards models to assess factors associated with QTcF≥501ms.

Results

Among 321 patients, 59 (18.4%) patients had QTcF≥501ms during a mean follow-up of 242 days (median 189, range 4–1091). The median maximum increase of QTcF was 43.4 ms (IQR 31.3–65.9) in patients treated with clofazimine. Treatment with clofazimine was significantly associated with QTcF≥501ms as compared to without clofazimine (adjusted hazards ratio (adjHR) 4.35, 95% confidence interval (CI) 2.01–9.44). Among patients not treated with bedaquiline and delamanid, those treated with clofazimine and a fluoroquinolone (adjHR 3.43, 95% CI 1.61–7.34) and those treated with clofazimine and high dose moxifloxacin (adjHR 6.54, 95% CI 2.43–17.60) had a significantly higher risk of QTcF≥501ms as compared to those treated with a fluoroquinolone without other QTcF prolonging agents. Four (1.6%) patients had documented ventricular tachycardia, in which one was Torsade de pointes. One patient was found to have sudden death during hospitalization.

Conclusions

Clofazimine was significantly associated with an increased risk of QTcF prolongation. QTcF≥501ms was potentially associated with fatal event and needed to be managed cautiously.

背景:贝达喹啉、delamanid和氟喹诺酮类药物与QTcF延长有关。氯法齐明是否与QTcF延长有关尚不清楚:纳入2017年5月至2019年12月期间入组的所有耐利福平肺结核患者。对接受常规方案治疗的患者在基线、第1个月、第3个月和第6个月进行心电图检查,对接受贝达喹啉、地拉那米德和短方案治疗的患者在额外的时间点进行心电图检查。我们估算了 QTcF 的最大增幅,并构建了 cox 比例危险模型来评估与 QTcF≥501ms 相关的因素:在 321 名患者中,有 59 名(18.4%)患者在平均 242 天(中位数 189 天,范围 4-1091 天)的随访期间 QTcF≥501ms 。在接受氯法齐明治疗的患者中,QTcF的最大增幅中位数为43.4毫秒(IQR为31.3-65.9)。与不使用氯唑明相比,使用氯唑明治疗与 QTcF≥501ms 显著相关(调整危险比 (adjHR) 4.35,95% 置信区间 (CI) 2.01-9.44)。在未接受贝达喹啉和地拉马尼治疗的患者中,接受氯法齐明和氟喹诺酮治疗的患者(adjHR为3.43,95% CI为1.61-7.34)和接受氯法齐明和大剂量莫西沙星治疗的患者(adjHR为6.54,95% CI为2.43-17.60)与接受氟喹诺酮治疗且未使用其他QTcF延长药物的患者相比,QTcF≥501ms的风险明显更高。4例(1.6%)患者有室性心动过速记录,其中1例为室性心动过速。一名患者在住院期间猝死:结论:氯法齐明与 QTcF 延长风险的增加有显著相关性。QTcF≥501ms可能与致命事件有关,需要谨慎处理。
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引用次数: 0
Bacterial profile, and independent predictors for healthcare-associated pneumonia persistently caused by multidrug-resistant Gram-negative bacteria for patients with the preceding multidrug-resistant Gram-negative pneumonia in Taiwan 台湾曾患耐多药革兰氏阴性菌肺炎的患者的细菌概况,以及耐多药革兰氏阴性菌持续引发医护人员相关肺炎的独立预测因素。
IF 4.5 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-06 DOI: 10.1016/j.jmii.2024.07.009
Li-Kuo Kuo , Hou-Tai Chang , Shun-Chung Hsueh , I-Min Liu , Po-Chuen Hsieh , Shio-Shin Jean

Objectives

To understand the microbial profile and investigate the independent predictors for healthcare-associated pneumonia (HCAP) pertinaciously caused by isolates of multidrug-resistant (MDR) Gram-negative bacteria (GNB).

Methods

Multicenter ICU patients who received appropriate antibiotic treatments for preceding pneumonia due to MDR GNB isolates and subsequently developed HCAP caused by either MDR GNB (n = 126) or non-MDR GNB (n = 40) isolates in Taiwan between 2018 and 2023 were enrolled. Between the groups of patients with HCAP due to MDR GNB and non-MDR GNB, the proportions of the following variables, including demographic characteristics, important co-morbidities, nursing home residence, physiological severity, intervals between two hospitalizations, steroid use, the tracheostomy tube use alone, ventilator support, and the predominant GNB species involving HCAP, were analyzed using the chi-square test. Logistic regression was employed to explore the independent predictors for HCAP persistently caused by MDR GNB in the aforementioned variables with a P-value of <0.15 in the univariate analysis.

Results

MDR-Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii complex were the three predominant species causing HCAP. Chronic structural lung disorders, diabetes mellitus, intervals of ≤30 days between two hospitalizations, use of the tracheostomy tube alone, and prior pneumonia caused by MDR A. baumannii complex were shown to independently predict the HCAP tenaciously caused by MDR GNB. Conversely, the preceding pneumonia caused by MDR P. aeruginosa was a negative predictor.

Conclusion

Identifying predictors for HCAP persistently caused by MDR GNB is crucial for prescribing appropriate antibiotics.

目的了解耐多药(MDR)革兰氏阴性菌(GNB)分离株引起的医护相关性肺炎(HCAP)的微生物概况,并研究其独立预测因素:方法:对2018年至2023年期间在台湾因MDR GNB分离菌引起肺炎而接受适当抗生素治疗,随后又因MDR GNB(126例)或非MDR GNB(40例)分离菌引起HCAP的多中心ICU患者进行了登记。在由 MDR GNB 和非 MDR GNB 引起的 HCAP 患者组之间,采用卡方检验分析了以下变量的比例,包括人口统计学特征、重要并发症、疗养院居住地、生理严重程度、两次住院间隔时间、类固醇使用情况、单独使用气管插管情况、呼吸机支持情况以及涉及 HCAP 的主要 GNB 菌种。采用逻辑回归法探讨上述变量中 MDR GNB 持续引起 HCAP 的独立预测因素,P 值为 结果:MDR-肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌复合菌是引起 HCAP 的三种主要菌种。慢性肺部结构性疾病、糖尿病、两次住院间隔时间少于 30 天、单独使用气管造口管以及之前由 MDR 鲍曼不动杆菌复合菌引起的肺炎均可独立预测由 MDR GNB 引起的顽固性 HCAP。相反,之前由 MDR 铜绿假单胞菌引起的肺炎则是一个负面预测因素:结论:确定 MDR GNB 引起的持续 HCAP 的预测因子对于开具适当的抗生素处方至关重要。
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引用次数: 0
Human Strongyloides stercoralis infection 人类盘尾丝虫感染
IF 7.4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-03 DOI: 10.1016/j.jmii.2024.07.010
Ruibing Yang, Meiyining Xu, Lichao zhang, Yao Liao, Yuheng Liu, Xiaoyan Deng, Lifu Wang
is an important soil-transmitted helminth occurring world-wide and affecting 30–100 million people. Because many cases are asymptomatic and sensitive diagnostic methods are lacking, infection is frequently underdiagnosed. The increasing incidence of autoimmune and wasting diseases and increased use of immunosuppressive agents, as well as the increased use of immunosuppressants and cytotoxic drugs, have increased infection and their mortality. This review provides information about epidemiology, life cycle, aetiology, pathology, comorbidities, immunology, vaccines, diagnosis, treatment, prevention, control and makes some recommendations for future prevention and control of this important parasite.
是一种重要的土壤传播蠕虫,发生在世界各地,影响 3 000 万至 1 亿人。由于许多病例无症状,且缺乏敏感的诊断方法,感染常常被漏诊。随着自身免疫性疾病和消耗性疾病发病率的增加,以及免疫抑制剂和细胞毒性药物使用量的增加,感染及其死亡率也随之上升。这篇综述提供了有关流行病学、生命周期、病因学、病理学、合并症、免疫学、疫苗、诊断、治疗、预防、控制等方面的信息,并对这一重要寄生虫的未来预防和控制提出了一些建议。
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引用次数: 0
Validation of a modified enrichment broth for efficient screening of group B Streptococcus in pregnant women. 验证改良富集肉汤,以有效筛查孕妇体内的 B 群链球菌。
IF 4.5 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-03 DOI: 10.1016/j.jmii.2024.07.015
Daiki Tanno, Kyoichi Saito, Yasuaki Tomii, Yukari Nakatsuka, Kohei Uechi, Kazutaka Ohashi, Yukio Yamadera, Atsuko Hata, Masahiro Toyokawa, Hiroki Shimura

We validated a modified enrichment broth that changes its color when group B Streptococcus (GBS) grows. No GBS was detected in any of the non-yellow samples. Thus, the non-yellow samples were considered GBS-negative without conducting further examinations, potentially reducing medical costs and workload.

我们验证了一种改良的富集肉汤,当 B 群链球菌(GBS)生长时,肉汤会变色。在非黄色样本中均未检测到 GBS。因此,非黄色样本被认为是 GBS 阴性样本,无需进行进一步检查,从而降低了医疗成本和工作量。
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引用次数: 0
RAGE participates in the intracellular transport of Campylobacter jejuni cytolethal distending toxin RAGE 参与空肠弯曲杆菌细胞致死膨胀毒素的细胞内转运。
IF 4.5 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-03 DOI: 10.1016/j.jmii.2024.07.007
Yu-Fang Chang , Yi-Ping Huang , Chia-Huei Chou , Mao-Wang Ho , Hwai-Jeng Lin , Chun-Ya Chen , Hui-Yu Wu , Yi-Ru Lai , Yuan-Haw Lee , Cheng-Hsun Chiu , Chih-Ho Lai

Background

Cytolethal distending toxin (CDT) belongs to the genotoxin family and is closely related to Campylobacter jejuni-associated gastroenteritis. We recently reported that CDT triggers the danger-associated molecular pattern (DAMP) signaling to exert deleterious effects on host cells. However, how CDT traffics in cells and the mechanism of CDT intoxication remain to be elucidated.

Methods

Recombinant CDT subunits (CdtA, CdtB, and CdtC) were purified, and their activity was characterized in gastrointestinal cells. Molecular approaches and image tracking were employed to analyze the delivery of CDT in host cells.

Results

In this study, we found that CDT interacts with the receptor of advanced glycation end products (RAGE) and high mobility group box 1 (HMGB1) to enter the cells. Our results further showed that CdtB transport in cells through the dynamin-dependent endocytic pathway and lysosome is involved in this process. Conversely, blockage of RAGE signaling resulted in a reduction in CDT-arrested cell cycles, indicating that RAGE is involved in CDT intracellular transport and its subsequent pathogenesis.

Conclusion

Our results demonstrate that RAGE is important for CDT trafficking in the cells. These findings expand our understanding of important issues related to host cell intoxication by C. jejuni CDT.

背景:细胞致死膨胀毒素(CDT)属于基因毒素家族,与空肠弯曲菌相关性胃肠炎密切相关。我们最近报道了 CDT 触发危险相关分子模式(DAMP)信号转导,对宿主细胞产生有害影响。然而,CDT如何在细胞内迁移以及CDT中毒的机制仍有待阐明:方法:纯化重组 CDT 亚基(CdtA、CdtB 和 CdtC)并鉴定其在胃肠道细胞中的活性。我们采用分子方法和图像追踪技术分析了 CDT 在宿主细胞中的传递情况:结果:在这项研究中,我们发现 CDT 与高级糖化终产物受体(RAGE)和高迁移率基团框 1(HMGB1)相互作用,从而进入细胞。我们的研究结果进一步表明,CdtB 在细胞内的转运是通过依赖 dynamin 的内细胞途径进行的,溶酶体参与了这一过程。相反,阻断 RAGE 信号传导会导致 CDT 停滞细胞周期的减少,这表明 RAGE 参与了 CDT 的胞内转运及其随后的发病机制:我们的研究结果表明,RAGE 对 CDT 在细胞内的转运具有重要作用。结论:我们的研究结果表明,RAGE 对 CDT 在细胞内的转运具有重要作用。这些发现拓展了我们对空肠病菌 CDT 致宿主细胞中毒相关重要问题的认识。
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引用次数: 0
Clinical characteristics and outcomes of patients with candidemia during the COVID-19 pandemic: Insights from experience in the Omicron era COVID-19 大流行期间念珠菌血症患者的临床特征和预后:从 Omicron 时代的经验中获得的启示。
IF 4.5 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-03 DOI: 10.1016/j.jmii.2024.07.014
Geng-Lou Lin , Po-Hsun Chang , Ing-Kit Lee , Yi-Chun Chen , Chen-Hsiang Lee

Background

In Taiwan, COVID-19 outbreaks caused by the Omicron variant occurred in 2022. We investigated the incidence of candidemia during COVID-19 pandemic and the mortality of candidemia patients with COVID-19 in Taiwan.

Methods

The incidence of candidemia and fluconazole susceptibility of Candida species before (2015–2019) and during COVID-19 pandemic (2020–2023) at Kaohsiung Chang Gung Memorial Hospital were investigated. The associated factors with mortality in candidemia patients during COVID-19 pandemic were analyzed. Candidemia patients who had COVID-19 within the prior 90 days (case group, n = 34) were propensity-score matched for age, ICU admission, and abdominal surgery in a 1:4 ratio with candidemia patients without COVID-19 (control group, n = 136).

Results

Age (adjusted odds ratio [AOR] = 1.02, 95% CI: 1.01–1.03), ICU stay (AOR = 1.84, 95% CI: 1.29–2.62), higher Charlson comorbidity index (AOR = 1.08, 95% CI: 1.03–1.13), corticosteroid use (AOR = 1.50, 95% CI: 1.04–2.17) were associated with increased risk of mortality; abdominal surgery (AOR = 0.47, 95% CI: 0.29–0.74) and infected by Candida parapsilosis (AOR = 0.61, 95% CI: 0.38–0.98) were associated with decreased risk of mortality. After matching, there was no significant difference in mortality rates between the case and control groups. The incidence of candidemia increased from 196 to 278 patients/100,000 admissions during COVID-19 pandemic, while the causative species of candidemia and fluconazole susceptibility rates were similar.

Conclusion

While the incidence of candidemia increased during COVID-19 pandemic, there was no significant difference in mortality between candidemia patients with and without COVID-19 in the Omicron era.

背景:台湾在2022年爆发了由Omicron变种引起的COVID-19。我们调查了台湾 COVID-19 大流行期间念珠菌血症的发病率以及 COVID-19 念珠菌血症患者的死亡率:方法:调查了高雄长庚纪念医院在 COVID-19 大流行之前(2015-2019 年)和期间(2020-2023 年)念珠菌血症的发病率以及念珠菌对氟康唑的敏感性。分析了COVID-19大流行期间念珠菌病患死亡率的相关因素。将在 90 天内感染过 COVID-19 的念珠菌病患者(病例组,n = 34)与未感染过 COVID-19 的念珠菌病患者(对照组,n = 136)按 1:4 的比例在年龄、入住 ICU 和腹部手术方面进行倾向得分匹配:结果:年龄(调整赔率[AOR] = 1.02,95% CI:1.01-1.03)、入住 ICU(AOR = 1.84,95% CI:1.29-2.62)、较高的 Charlson 合并症指数(AOR = 1.08,95% CI:1.03-1.13)、使用皮质类固醇(AOR = 1.50,95% CI:1.04-2.17)与念珠菌病风险增加相关。腹部手术(AOR = 0.47,95% CI:0.29-0.74)和副丝状念珠菌感染(AOR = 0.61,95% CI:0.38-0.98)与死亡风险增加有关。匹配后,病例组和对照组的死亡率无明显差异。在COVID-19大流行期间,念珠菌血症的发病率从196例/10万住院患者上升到278例/10万住院患者,而念珠菌血症的致病菌种类和氟康唑敏感率却相似:结论:虽然在 COVID-19 大流行期间,念珠菌血症的发病率有所上升,但在 Omicron 时代,感染 COVID-19 和未感染 COVID-19 的念珠菌血症患者的死亡率并无明显差异。
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引用次数: 0
期刊
Journal of Microbiology Immunology and Infection
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