Journal of Microbiology Immunology and Infection最新文献

Background: Healthcare workers (HCWs) have increased risks of active tuberculosis, yet there are limited reports of incidence and risk factors of latent tuberculosis infection (LTBI) among HCWs.

Methods: HCWs were enrolled from four medical centers in Taiwan. Quantiferon-TB Gold Plus Test (QFT-Plus) was performed initially and 9-12 months afterwards. The prevalence, incidence, and clinical factors associated with LTBI, and willingness to receive LTBI treatment were explored.

Results: Among 297 HCWs, the prevalence rate of LTBI was 10.8 %. The independent factors associated with prevalent LTBI were age >40 years old (aOR 3.52, 95 % CI 1.46-8.45), health professionals (aOR 3.99, 95 % CI 1.02-15.65), and working in intensive care units (ICUs) (aOR 4.06, 95 % CI 1.28-12.86). Having all three factors escalated the risk of prevalent LTBI (aOR 13.81, 95 % CI 3.16-60.37). Of 129 LTBI-free HCWs undergoing 2nd QFT-Plus, seven (5.4 %) had positive conversion, indicating incident LTBI, among which four had TB contacts without wearing N95 mask. Two had a TB2-TB1 value > 0.6 IU/ml. 40.6 % prevalent LTBI patients refused LTBI preventive therapy.

Conclusions: More advanced age, health professionals, and working in ICUs were independent factors associated with prevalent LTBI. Most healthcare workers with incident LTBI cases had TB contacts without wearing N95 masks.

Background: Type 1 diabetes mellitus (T1D) is an autoimmune disorder characterized by immune-mediated destruction of pancreatic β-cells, resulting in lifelong insulin dependence. Interleukin-17A (IL-17A), associated with T1D progression and complications, can mobilize and activate neutrophils to release lytic enzymes, reactive oxygen species, and cytokines, thereby promoting systemic inflammation and cell destruction; such neutrophil-driven responses have also been implicated in autoimmune diseases, including diabetes. This study aimed to compare the clinical characteristics and neutrophil stress of IL-17A-positive and -negative T1D patients.

Methods: 37 patients were enrolled between May 2023 and April 2024 at Department of Pediatric Endocrinology, Changhua Christian Children's Hospital. In addition to clinical characteristics, peripheral blood neutrophils were isolated to analyze antioxidant-related protein, autophagy, and respiratory bursts. Serum cytokine profiles were also assessed.

Results: 27 patients were IL-17A-positive. At disease onset, they were younger and had lower absolute neutrophil counts. Years later, they showed higher LDL, with HDL declining over time and TG trending upward. All participants were Vitamin D insufficiency, and IL-17A levels correlated positively with vitamin D levels. Neutrophils in the peripheral blood displayed reduced xCT, GPX4, and HO-1, increased LC3II/LC3I ratios with decreased p62, and greater ROS production upon stimulation. Serum IL-5 levels were significantly higher, with eotaxin trending higher.

Conclusion: IL-17A-positive T1D is associated with earlier onset. As the disease progresses, it leads to an increased risk of dyslipidemia and the development of type 2 inflammation. Furthermore, the neutrophils in these patients suggestive of ferroptosis, defining a distinct phenotype for potential targeted therapy.

Background: Since coronavirus disease 2019 (COVID-19) pandemic, its variants have challenged vaccine effectiveness and immunity, particularly among high-risk individuals. Assessment of the risk of severe COVID-19 in these populations is crucial for informed therapeutic decisions. We aim to correlate early quantitative SARS-CoV-2 spike antibody (S ab) levels in SARS-CoV-2 infections with the risk of severe COVID-19.

Methods: We conducted a retrospective cohort study of hospitalized patients with early-stage COVID-19 and S ab titers between April 2021 and June 2022. S ab titers were stratified into four categories: <500 units/milliliter (U/mL), 500 to <1500 U/mL, 1500 to <5000 U/mL and ≥5000 U/mL, and their effects on the risk of severe COVID-19 were analyzed. Severe COVID-19 was defined as the development of pneumonia requiring oxygen supplementation, intensive care unit (ICU) admission, or death.

Results: Among the 1665 patients with early-stage COVID-19, 61(3.66 %) developed severe COVID-19. S ab titers were significantly lower in patients who developed severe COVID-19; 72.13 % of these patients had titers below 500 U/mL, whereas 24.19 % of the patients in the non-severe group (P < 0.01) had titers below 500 U/mL during the Delta and Omicron periods. Patients with S ab titers ≥5000 U/mL had an adjusted odds ratio of 0.12 (95 % CI: 0.05-0.33, P < 0.01) for severe COVID-19 compared with those with titers <500 U/mL, independent of vaccination status, variant period, and comorbidities.

Conclusion: S ab titers less than 500 U/mL are associated with an increased risk of severe COVID-19. The quantitative S ab titer may serve as a practical surrogate for SARS-CoV-2 immunity.

Background: This study aimed to evaluate the ability of tuberculin skin test (TST) and interferon-gamma release assay (IGRA) to predict progression of latent tuberculosis (LTBI) to active tuberculosis.

Methods: We searched PubMed, Embase, Web of Science, and the Cochrane Library for cohort studies published until October 6, 2024, that used both IGRA and TST to detect LTBI and reported data on active TB development. We assessed the predictive value of IGRA and TST for disease progression by calculating the risk ratio (RR), which compares the progression rates between positive and negative individuals for each test.

Results: Out of 2650 potentially eligible studies, 260 were reviewed in full text, and 44 studies with 25637 individuals were included. The pooled RR for disease progression was higher with IGRA than with TST (5.38 [95 % CI: 3.44-8.40] vs. 3.03 [95 % CI: 1.20-4.10]), although this difference did not reach statistical significance (p = 0.0713). PPV with IGRA vs TST: 2.50 % [95 % CI: 1.20 %-4.10 %] vs 1.30 % [95 % CI: 0.60 %-2.40 %] (p = 0.4852). NPV with IGRA vs TST: 99.70 % [95 % CI: 99.40 %-99.90 %] vs 99.60 % [95 % CI: 99.30 %-99.90 %] (p = 0.9630). Furthermore, the PPV of IGRA was similar to the progression rate of IGRA+/TST+ (2.00 % [95 % CI: 0.05 %-4.40 %] vs. 2.50 % [95 % CI: 0.40 %-6.10 %]). Finally, while IGRA identified fewer positive individuals (23.90 % [95 % CI: 18.50 %-29.80 %] vs. 52.20 % [95 % CI: 34.30 %-69.80 %]), the number of positive individuals progressing was similar (265 vs. 268), with similar results also observed in the untreated population.

Conclusions: IGRA appears to have superior predictive value for TB progression compared to TST. Additionally, incorporating TST alongside IGRA does not seem to significantly enhance predictive accuracy. IGRA effectively reduces the number of individuals requiring treatment while seemingly not missing those at risk of progression.

Background: ED-initiated outpatient parenteral antimicrobial therapy (OPAT) aims to reduce admissions and relieve ED boarding. In practice, however, OPAT may be used as a "middle-ground" alternative to oral therapy, complicating assessment of its true value. Because studies using matched inpatient and outpatient comparators with longitudinal endpoints are scarce, we evaluated the effectiveness, safety, and medical costs of an ED-initiated OPAT program in Taiwan.

Methods: This retrospective cohort study analyzed ED-initiated OPAT patients from two teaching hospitals (2017-2019). Using coarsened exact matching, we created two comparison groups: inpatient-matched (assessing effectiveness) and outpatient-matched (assessing safety). The primary outcome was net hospital days saved over 30 days, derived from daily hospital-prevalence trajectories. Secondary outcomes were 14-day cumulative incidence of ED revisits/readmission and a stratified cost analysis over the treatment course.

Results: Of 1409 OPAT patients, 986 were matched. In the inpatient-matched cohort (n = 416), OPAT saved a net 8.9 hospital-days per patient over 30 days. In the outpatient-matched cohort (n = 570), OPAT showed a transiently higher risk of return visits at day 7 (risk difference +5 %; p = 0.008) without increases in severe adverse events or 14-day readmissions. OPAT reduced costs by NT$34,367 per patient when substituting for hospitalization but increased costs when compared with standard outpatient care.

Conclusions: For appropriately selected patients requiring admission-level care, ED-initiated OPAT can be a cost-saving substitute for hospitalization. Given limited safety data, benefits remain conditional on rigorous patient selection to avoid overuse and on structured early reassessment to mitigate early revisit risks.