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Gut microbiota compositions in the carriers and noncarriers of third-generation cephalosporin–resistant Escherichia coli: A study among children in southern Taiwan 耐第三代头孢菌素大肠杆菌携带者和非携带者的肠道微生物群组成:对台湾南部儿童的研究
IF 7.4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-28 DOI: 10.1016/j.jmii.2024.08.010
Keng-Chin Yang, Wan-Yu Tien, Ming-Fang Cheng
Antimicrobial resistance, particularly in third-generation cephalosporin–resistant (3GC-R) (), poses major global health challenges and has various clinical implications. Researchers have explored the relationship between extended-spectrum β-lactamase–producing and gut microbiota composition, which influence host health and disease susceptibility, in adults. In this study, we analyzed gut microbiota composition in Taiwanese children by the colonization status of 3GC-R . This cross-sectional study included children (age, 0–6 years) from Kaohsiung, Taiwan. Fecal samples were subjected to microbiological and gut microbiome (full-length 16S rRNA sequencing) analyses. The antimicrobial susceptibility of colonies isolated from the samples was tested. Furthermore, gut microbiota compositions and diversity indices were compared between 3GC-R carriers and noncarriers. Approximately 46% of all children aged <6 years carried 3GC-R . The abundances of , , and (genus level) were higher in carriers than in noncarriers. By contrast, the abundances of (family level) and (genus level) were higher in noncarriers than in carriers. No significant between-group difference was observed in alpha diversity. However, a significant between-group difference was noted in beta diversity (unweighted UniFrac analysis). This is the first study that investigated differences in the gut microbiota between healthy 3GC-R carriers and noncarriers in children, suggesting potential mechanisms involving altered utilization of short-chain fatty acids and elevated succinate levels contributing to increased colonization of 3GC-R . The other taxa identified in this study may contribute to colonization resistance in the pediatric population.
抗菌药耐药性,尤其是耐第三代头孢菌素(3GC-R)(),对全球健康构成了重大挑战,并产生了各种临床影响。研究人员探讨了成人体内产生广谱β-内酰胺酶的微生物群与肠道微生物群组成之间的关系,后者影响宿主的健康和对疾病的易感性。在这项研究中,我们根据 3GC-R 的定植状况分析了台湾儿童的肠道微生物群组成。这项横断面研究纳入了台湾高雄的儿童(0-6 岁)。对粪便样本进行了微生物学和肠道微生物组(全长 16S rRNA 测序)分析。测试了从样本中分离出的菌落对抗菌药的敏感性。此外,还比较了 3GC-R 携带者和非携带者的肠道微生物群组成和多样性指数。在所有年龄小于 6 岁的儿童中,约有 46% 携带 3GC-R 。携带者中的、、和(属级)的丰度高于非携带者。相比之下,非携带者中(科级)和(属级)的含量高于携带者。在阿尔法多样性方面没有观察到明显的组间差异。然而,在贝塔多样性方面却发现了明显的组间差异(非加权 UniFrac 分析)。这是第一项调查儿童健康 3GC-R 携带者与非携带者之间肠道微生物群差异的研究,表明潜在的机制涉及短链脂肪酸利用的改变和琥珀酸水平的升高导致 3GC-R 的定植增加。本研究中发现的其他类群可能会导致儿科人群的定植抵抗。
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引用次数: 0
Characteristics and Prevalence of Vancomycin-variable Enterococcus faecium bacteremia in southern Taiwan. 台湾南部万古霉素变异性粪肠球菌菌血症的特征和流行率。
IF 4.5 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-24 DOI: 10.1016/j.jmii.2024.08.006
Chi-Jung Lu, Wei-Chun Hung, Zi-Han Lan, Po-Liang Lu, Chun-Yu Lin, Yen-Hsu Chen, Tun-Chieh Chen, Chung-Hao Huang, Ya-Ting Chang, Chun-Yuan Lee, Yu-Te Tsai, Shang-Yi Lin

Background: Vancomycin-variable enterococci (VVE) are vanA-carrying Enterococcus faecium that are phenotypically susceptible to vancomycin and can only be detected using molecular methods, leading to the possibility of treatment failure and posing threats to infection control. This study aimed to determine the prevalence of VVE and its associated clinical risk factors.

Methods: This retrospective study was conducted in two hospitals in southern Taiwan. Patients with phenotypically vancomycin-susceptible E. faecium bacteremia were enrolled between 2017 and 2021. VVEs were defined as isolates harboring the vanA gene that were phenotypically susceptible to vancomycin. Vancomycin-susceptible E. faecium (VSE) isolates were phenotypically susceptible to vancomycin and lacked vanA or vanB genes.

Results: Of the 142 enrolled patients, 121 (85.2%) had VSE and 21 (14.8%) had VVE. Resistance rates to penicillin, tetracycline, and fosfomycin were higher in VVE isolates. Malignancy (adjusted odds ratio [aOR] = 4.87; 95% confidence interval [CI] 1.54-15.41, p = 0.007) and central venous catheter usage (aOR = 4.69; 95% CI 1.49-14.78, p = 0.008) were the independent risk factors associated with VVE bacteremia. Being male (aOR = 0.12, CI 0.03-0.44, p = 0.002) was less likely to be associated with VVE bacteremia. Although VVE was not associated with 30-day mortality (38.1% [VVE] vs. 35.5% [VSE], p = 0.822), one case of subsequent vancomycin-resistant enterococci infection in the VVE group with vancomycin treatment (4.8%, 1/21) was identified, which led to subsequent mortality.

Conclusions: The prevalence of VVE was high among E. faecium isolates with vancomycin-susceptible phenotypes in southern Taiwan. Although the current study revealed that VVE bacteremia was not associated with poor clinical outcome, further multicenter surveillance survey is recommended to evaluate the possible impact of VVE on public health in Taiwan.

背景:万古霉素变异性肠球菌(VVE)是一种携带万古霉素表型易感性的粪肠球菌,只能通过分子方法检测,可能导致治疗失败并对感染控制构成威胁。本研究旨在确定VVE的发病率及其相关临床风险因素:这项回顾性研究在台湾南部的两家医院进行。2017年至2021年期间,表型为万古霉素易感粪肠球菌菌血症的患者被纳入研究。VVE被定义为携带vanA基因且表型上对万古霉素敏感的分离株。万古霉素敏感粪肠球菌(VSE)分离株对万古霉素表型敏感,但缺乏vanA或vanB基因:结果:在 142 名入选患者中,121 人(85.2%)有 VSE,21 人(14.8%)有 VVE。VVE 分离物对青霉素、四环素和磷霉素的耐药率较高。恶性肿瘤(调整后比值比 [aOR] = 4.87;95% 置信区间 [CI] 1.54-15.41,p = 0.007)和使用中心静脉导管(aOR = 4.69;95% CI 1.49-14.78,p = 0.008)是与 VVE 菌血症相关的独立风险因素。男性(aOR = 0.12,CI 0.03-0.44,p = 0.002)与 VVE 菌血症相关的可能性较小。虽然 VVE 与 30 天死亡率无关(38.1% [VVE] vs. 35.5% [VSE],p = 0.822),但在接受万古霉素治疗的 VVE 组中发现了一例随后感染耐万古霉素肠球菌的病例(4.8%,1/21),这导致了随后的死亡:结论:在台湾南部具有万古霉素敏感表型的粪肠球菌分离株中,VVE的流行率很高。尽管目前的研究表明,VVE菌血症与不良临床结果无关,但建议进一步开展多中心监测调查,以评估VVE对台湾公共卫生可能造成的影响。
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引用次数: 0
Clinical manifestations and viral kinetics of people with Mpox: A case series during the 2023 outbreak in Taiwan. 腮腺炎患者的临床表现和病毒动力学:2023 年台湾疫情爆发期间的病例系列。
IF 4.5 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-23 DOI: 10.1016/j.jmii.2024.08.008
Kai-Hsiang Chen, Wang-Da Liu, Kuo-Chen Weng, Hui-Hou Chen, Shu-Yuan Ho, Yu-Shan Huang, Tzong-Yow Wu, Guei-Chi Li, Sui-Yuan Chang, Chien-Ching Hung

Monkeypox (Mpox) has emerged as a global threat since 2022. We reported 14 cases of Mpox in 10 people with HIV (PWH) and 4 people without HIV (PWoH), of whom 64.3% had sexually transmitted co-infections. Severe complications of Mpox and prolonged viral shedding might occur in both PWH and PWoH.

猴痘(Mpox)自 2022 年以来已成为一种全球性威胁。我们报告了10名艾滋病病毒感染者(PWH)和4名非艾滋病病毒感染者(PWoH)中的14例猴痘病例,其中64.3%的患者合并有性传播感染。艾滋病病毒感染者和非艾滋病病毒感染者都有可能出现梅毒的严重并发症和长期病毒脱落。
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引用次数: 0
Cryptococcosis in wait-listed liver transplant candidates: Prevalence, manifestations, and risk factors 肝移植候选者中的隐球菌病:发病率、表现和风险因素
IF 7.4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-23 DOI: 10.1016/j.jmii.2024.08.001
Wan-Ting Tsai, Aristine Cheng, Yu-Chung Chuang, Cheng-Maw Ho, Yao-Ming Wu, Ming-Chih Ho, Hsin-Yun Sun, Ray-Hung Hu, Yee-Chun Chen
Liver cirrhosis compromises immunity against cryptococcosis, and liver transplant recipients tend to develop the disease earlier after transplantation, possibly due to unrecognized pretransplant infection. We assessed the prevalence and characteristics of cryptococcosis among liver transplant candidates and whether pre-transplant cryptococcal antigen (CrAg) can detect the disease before transplantation. We retrospectively included liver transplant candidates in a tertiary hospital during 2017–2022. Serum CrAg and pulmonary computed tomography were incorporated in routine transplant evaluation. Other investigations were done if indicated. Cryptococcosis was diagnosed by positive culture or CrAg. Risk factors for cryptococcosis were also assessed. Of the 377 candidates with a median MELD-Na score of 18, 84.4% had hepatitis B virus (HBV) infection. Cryptococcosis was diagnosed in 10 (2.6%) candidates, by CrAg in 6, culture in 2, or both in 2. Only 3 had fever, and 3 were asymptomatic; 7 had pulmonary cryptococcosis. Of the 10 candidates with cryptococcosis, one underwent transplantation after 143-day antifungals. Of the 87 candidates undergoing liver transplantation, one (1.2%) recipient developed cryptococcosis 14 days post-transplant with negative CrAg three weeks before transplantation. HBsAg-positive chronic HBV infection with HBV DNA loads <2000 IU/mL was significantly associated with cryptococcosis (odds ratio 4.4, 95% confidence interval 1.2–16.5, p = 0.03) after the adjustment of MELD-Na score. The prevalence of cryptococcosis was 2.6% among our liver transplant candidates and CrAg detected 80% of the cases. Disease presentation was mild and pulmonary disease predominated. HBsAg-positive chronic HBV infection with HBV DNA loads <2000 IU/mL was significantly associated with cryptococcosis.
肝硬化损害了对隐球菌病的免疫力,而肝移植受者往往在移植后更早发病,这可能是由于移植前感染未被发现所致。我们评估了肝移植受者中隐球菌病的发病率和特征,以及移植前隐球菌抗原(CrAg)是否能在移植前检测出这种疾病。我们回顾性纳入了 2017-2022 年间一家三甲医院的肝移植候选者。血清 CrAg 和肺部计算机断层扫描被纳入常规移植评估。如有必要,还进行了其他检查。隐球菌病通过培养或CrAg阳性确诊。还对隐球菌病的风险因素进行了评估。在中位 MELD-Na 评分为 18 分的 377 名候选者中,84.4% 感染了乙型肝炎病毒 (HBV)。只有 3 人发烧,3 人无症状;7 人患有肺隐球菌病。在患有隐球菌病的 10 名候选者中,有一人在服用了 143 天的抗真菌药物后接受了移植手术。在 87 名接受肝移植的候选者中,有一名(1.2%)受者在移植后 14 天患了隐球菌病,而在移植前三周 CrAg 阴性。经 MELD-Na 评分调整后,HBsAg 阳性且 HBV DNA 负荷小于 2000 IU/mL 的慢性 HBV 感染与隐球菌病显著相关(几率比 4.4,95% 置信区间 1.2-16.5,p = 0.03)。在我们的肝移植患者中,隐球菌病的发病率为 2.6%,而 CrAg 检测出的病例占 80%。患者病情较轻,以肺部疾病为主。HBsAg 阳性的慢性 HBV 感染且 HBV DNA 负荷小于 2000 IU/mL,与隐球菌病明显相关。
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引用次数: 0
Lactate dehydrogenase-1 may play a key role in the brain energy disturbance caused by cryptococcal meningitis. 乳酸脱氢酶-1 可能在隐球菌脑膜炎引起的脑能量紊乱中发挥关键作用。
IF 4.5 2区 医学 Q2 IMMUNOLOGY Pub Date : 2024-08-23 DOI: 10.1016/j.jmii.2024.08.009
Qingdong Zhu, Qian Long, Cailing Wei, Jieling Chen, Lanwei Nong, Jianglong Qin, Zhizhong Huang, Yanqing Zheng, Sijun Li

Background: Cryptococcal meningitis (CM) may affect the conversion of lactate to pyruvate in the brain, resulting in abnormal levels of adenosine triphosphate (ATP) throughout the brain. Lactate conversion to pyruvate is mainly caused by lactic dehydrogenase 1 (LDH1), which is composed of four LDHB subunits. However, the underlying mechanism of LDH1 in CM remains unclear.

Methods: Cerebrospinal fluid (CSF) from 17 patients was collected, including eight patients with non-infectious diseases of the central nervous system and nine patients with CM. Based on clinical data and laboratory reports, data regarding intracranial pressure, CSF white cell counts, lactate dehydrogenase (LDH), adenosine deaminase, glucose, protein, and chloridion were collected. Meanwhile, LDH1, LDH5, lactate, pyruvate, and ATP levels were detected in CSF. Whereafter, the levels of lactate, pyruvate, ATP, and the amplitude and frequency of action potentials in the neurons with low expression of LDHB were explored.

Results: Intracranial pressure and white cell count in CSF were significantly increased in patients with CM. In patients with CM, the LDH1, pyruvate, and ATP levels in the CSF were significantly decreased, and the levels of lactate were found to be increased. Furthermore, pyruvate and ATP levels were decreased, while lactate was increased in the neurons with low expression of LDHB. The amplitude and frequency of APs in the neurons with low expression of LDHB were significantly decreased.

Conclusion: Reduced levels of LDH1 in the brain of patients with CM may lead to increased lactate levels, decreased pyruvate and ATP levels, and negatively affect neuronal activity.

背景:隐球菌脑膜炎(CM)可能会影响大脑中乳酸向丙酮酸的转化,导致整个大脑的三磷酸腺苷(ATP)水平异常。乳酸转化为丙酮酸主要是由乳酸脱氢酶 1(LDH1)引起的,LDH1 由四个 LDHB 亚基组成。然而,LDH1 在 CM 中的基本机制仍不清楚:收集了 17 名患者的脑脊液(CSF),其中包括 8 名中枢神经系统非感染性疾病患者和 9 名 CM 患者。根据临床数据和实验室报告,收集了有关颅内压、脑脊液白细胞计数、乳酸脱氢酶(LDH)、腺苷脱氨酶、葡萄糖、蛋白质和氯离子的数据。同时,检测 CSF 中的 LDH1、LDH5、乳酸、丙酮酸和 ATP 水平。随后,研究了 LDHB 低表达神经元的乳酸、丙酮酸、ATP 水平以及动作电位的振幅和频率:结果:CM 患者的颅内压和 CSF 中的白细胞计数明显升高。CM患者脑脊液中的LDH1、丙酮酸和ATP水平明显下降,乳酸水平升高。此外,在 LDHB 低表达的神经元中,丙酮酸和 ATP 水平降低,而乳酸水平升高。LDHB 低表达神经元的 AP 振幅和频率明显降低:结论:CM 患者脑中 LDH1 水平降低可能导致乳酸水平升高、丙酮酸和 ATP 水平降低,并对神经元活动产生负面影响。
{"title":"Lactate dehydrogenase-1 may play a key role in the brain energy disturbance caused by cryptococcal meningitis.","authors":"Qingdong Zhu, Qian Long, Cailing Wei, Jieling Chen, Lanwei Nong, Jianglong Qin, Zhizhong Huang, Yanqing Zheng, Sijun Li","doi":"10.1016/j.jmii.2024.08.009","DOIUrl":"https://doi.org/10.1016/j.jmii.2024.08.009","url":null,"abstract":"<p><strong>Background: </strong>Cryptococcal meningitis (CM) may affect the conversion of lactate to pyruvate in the brain, resulting in abnormal levels of adenosine triphosphate (ATP) throughout the brain. Lactate conversion to pyruvate is mainly caused by lactic dehydrogenase 1 (LDH1), which is composed of four LDHB subunits. However, the underlying mechanism of LDH1 in CM remains unclear.</p><p><strong>Methods: </strong>Cerebrospinal fluid (CSF) from 17 patients was collected, including eight patients with non-infectious diseases of the central nervous system and nine patients with CM. Based on clinical data and laboratory reports, data regarding intracranial pressure, CSF white cell counts, lactate dehydrogenase (LDH), adenosine deaminase, glucose, protein, and chloridion were collected. Meanwhile, LDH1, LDH5, lactate, pyruvate, and ATP levels were detected in CSF. Whereafter, the levels of lactate, pyruvate, ATP, and the amplitude and frequency of action potentials in the neurons with low expression of LDHB were explored.</p><p><strong>Results: </strong>Intracranial pressure and white cell count in CSF were significantly increased in patients with CM. In patients with CM, the LDH1, pyruvate, and ATP levels in the CSF were significantly decreased, and the levels of lactate were found to be increased. Furthermore, pyruvate and ATP levels were decreased, while lactate was increased in the neurons with low expression of LDHB. The amplitude and frequency of APs in the neurons with low expression of LDHB were significantly decreased.</p><p><strong>Conclusion: </strong>Reduced levels of LDH1 in the brain of patients with CM may lead to increased lactate levels, decreased pyruvate and ATP levels, and negatively affect neuronal activity.</p>","PeriodicalId":56117,"journal":{"name":"Journal of Microbiology Immunology and Infection","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115172","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
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。
{"title":"The clinical impact of primary granulocyte-colony stimulating factor prophylaxis in children with acute lymphoblastic leukemia who underwent induction chemotherapy.","authors":"Yi-An Lu, Hsi-Che Liu, Jen-Yin Hou, Nan-Chang Chiu, Ting-Huan Huang, Ting-Chi Yeh","doi":"10.1016/j.jmii.2024.08.004","DOIUrl":"https://doi.org/10.1016/j.jmii.2024.08.004","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":56117,"journal":{"name":"Journal of Microbiology Immunology and Infection","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094249","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
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。
{"title":"Predictors of liver fibrosis changes assessed by paired liver biopsies in chronic hepatitis C patients treated with direct-acting antivirals.","authors":"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","doi":"10.1016/j.jmii.2024.08.005","DOIUrl":"https://doi.org/10.1016/j.jmii.2024.08.005","url":null,"abstract":"<p><strong>Background/purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 10<sup>3</sup>/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/m<sup>2</sup> (OR = 21.666, p = 0.009), sofosbuvir/ribavirin use (OR = 29.465, p = 0.031), platelet counts <119 10<sup>3</sup>/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).</p><p><strong>Conclusion: </strong>For DAA-treated CHC patients, those with baseline age <65 years, fibrosis stages <3, hemoglobin levels ≥12.5 g/dL, or platelet counts ≥160 10<sup>3</sup>/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/m<sup>2</sup>, sofosbuvir/ribavirin use, platelet counts <119 10<sup>3</sup>/μL, or the absence of early ALT normalization at 4 weeks after baseline.</p>","PeriodicalId":56117,"journal":{"name":"Journal of Microbiology Immunology and Infection","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115173","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
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。
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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。
{"title":"Clofazimine and QT prolongation in the treatment of rifampicin-resistant tuberculosis: Findings of aDSM in Taiwan","authors":"Chou-Jui Lin ,&nbsp;Jin-Hua Chen ,&nbsp;Shun-Tien Chien ,&nbsp;Yi-Wen Huang ,&nbsp;Chih-Bin Lin ,&nbsp;Jen-Jyh Lee ,&nbsp;Chih-Hsin Lee ,&nbsp;Ming-Chih Yu ,&nbsp;Chen-Yuan Chiang","doi":"10.1016/j.jmii.2024.08.002","DOIUrl":"10.1016/j.jmii.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><p>Bedaquiline, delamanid and fluoroquinolones are associated with increased QTcF. Whether clofazimine is associated with QTcF prolongation is less clear.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":56117,"journal":{"name":"Journal of Microbiology Immunology and Infection","volume":"57 5","pages":"Pages 791-800"},"PeriodicalIF":4.5,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1684118224001464/pdfft?md5=09591c0da3b02e01c30cbeef369b0c1b&pid=1-s2.0-S1684118224001464-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Microbiology Immunology and Infection
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