Prosthetic Vascular Graft Infection (PVGI) is a rare but serious complication of open surgical repair of abdominal aortic aneurysm. We report a case of gas-forming abscesses associated with PVGI caused by Bacteroides fragilis identified from the drainage fluid and blood cultures.
Case presentation
A 67-year-old man with a complaint of worsening low back pain underwent an emergency open surgery due to abdominal aortic aneurysm. On postoperative day 18, an abdominal CT showed gas formation within the aneurysm. Gram staining of the drainage fluid revealed Gram-negative rods and 16S rRNA gene sequencing performed on the fluid identified B. fragilis, although the culture of the fluid was negative. PVGI caused by anaerobic bacteria such as Bacteroides spp. is relatively rare. The sensitivity of 16S rRNA gene sequencing for culture-negative specimens is generally low, but 16S rRNA sequencing-positive rate increases when a Gram stain of specimen is positive.
{"title":"Gas-forming abscess associated with prosthetic vascular graft infection caused by Bacteroides fragilis","authors":"Motoshi Iwao , Takehiro Hashimoto , Ryota Tanaka , Kazufumi Hiramatsu , Hiroki Itoh","doi":"10.1016/j.bjid.2025.104524","DOIUrl":"10.1016/j.bjid.2025.104524","url":null,"abstract":"<div><h3>Introduction</h3><div>Prosthetic Vascular Graft Infection (PVGI) is a rare but serious complication of open surgical repair of abdominal aortic aneurysm. We report a case of gas-forming abscesses associated with PVGI caused by <em>Bacteroides fragilis</em> identified from the drainage fluid and blood cultures.</div></div><div><h3>Case presentation</h3><div>A 67-year-old man with a complaint of worsening low back pain underwent an emergency open surgery due to abdominal aortic aneurysm. On postoperative day 18, an abdominal CT showed gas formation within the aneurysm. Gram staining of the drainage fluid revealed Gram-negative rods and 16S rRNA gene sequencing performed on the fluid identified <em>B. fragilis</em>, although the culture of the fluid was negative. PVGI caused by anaerobic bacteria such as <em>Bacteroides</em> spp. is relatively rare. The sensitivity of 16S rRNA gene sequencing for culture-negative specimens is generally low, but 16S rRNA sequencing-positive rate increases when a Gram stain of specimen is positive.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 3","pages":"Article 104524"},"PeriodicalIF":3.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143748539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-02DOI: 10.1016/j.bjid.2025.104521
Mariana Giorgi Barroso de Carvalho , Thatyane Veloso de Paula Amaral de Almeida , Nicolas de Albuquerque Pereira Feijóo , Rafael Quaresma Garrido , Giovanna lanini Ferraiuoli Barbosa , Wilma Félix Golebiovski , Bruno Zappa , Clara Weksler , Marcelo Goulart Correia , Cristiane da Cruz Lamas
Background
Infective Endocarditis (IE) is a serious disease, with high morbidity and mortality. Few case series come from middle- income countries. Our aim is to describe a case series of patients with IE treated at a reference center in Brazil and compare data to other countries.
Methods
A retrospective analysis of a prospectively implemented endocarditis database was conducted, including adult patients with definite IE, January 2006‒June 2023. A literature search and summary were done. Statistical analysis was performed using Jamovi®, version 1.2.2.
Results
There were 502 episodes of IE; mean age ± SD was 48.4±17.2 years. Community-acquired IE occurred in 64.7 %. Main predispositions were rheumatic valve disease (30.7 %), prostheses (31.5 %), and congenital heart disease (13.9 %). Transthoracic and transesophageal echocardiograms were performed in 85 % and 78 %, respectively. Left-sided IE predominated. Fever occurred in 90.6 %, new murmurs in 50.7 %, and embolism in 45 %. Blood cultures were negative in 33.1 %; frequent pathogens were oral streptococci (15.6 %), Staphylococcus aureus (10.0 %), and enterococci (12.8 %). Main complications were heart failure (58 %), renal failure (32.8 %), and splenic embolization (35.2 %). Surgery was performed in 83.6 %; overall in-hospital mortality was 25 %; surgical mortality was 21.3 %.
Conclusions
Blood culture negative left-sided IE predominated. The mortality rate was high but within the range of reported series. Surgery was performed frequently and patients who were operated on had lower mortality.
{"title":"Contemporary cohort study in adult patients with infective endocarditis","authors":"Mariana Giorgi Barroso de Carvalho , Thatyane Veloso de Paula Amaral de Almeida , Nicolas de Albuquerque Pereira Feijóo , Rafael Quaresma Garrido , Giovanna lanini Ferraiuoli Barbosa , Wilma Félix Golebiovski , Bruno Zappa , Clara Weksler , Marcelo Goulart Correia , Cristiane da Cruz Lamas","doi":"10.1016/j.bjid.2025.104521","DOIUrl":"10.1016/j.bjid.2025.104521","url":null,"abstract":"<div><h3>Background</h3><div>Infective Endocarditis (IE) is a serious disease, with high morbidity and mortality. Few case series come from middle- income countries. Our aim is to describe a case series of patients with IE treated at a reference center in Brazil and compare data to other countries.</div></div><div><h3>Methods</h3><div>A retrospective analysis of a prospectively implemented endocarditis database was conducted, including adult patients with definite IE, January 2006‒June 2023. A literature search and summary were done. Statistical analysis was performed using Jamovi®, version 1.2.2.</div></div><div><h3>Results</h3><div>There were 502 episodes of IE; mean age ± SD was 48.4±17.2 years. Community-acquired IE occurred in 64.7 %. Main predispositions were rheumatic valve disease (30.7 %), prostheses (31.5 %), and congenital heart disease (13.9 %). Transthoracic and transesophageal echocardiograms were performed in 85 % and 78 %, respectively. Left-sided IE predominated. Fever occurred in 90.6 %, new murmurs in 50.7 %, and embolism in 45 %. Blood cultures were negative in 33.1 %; frequent pathogens were oral streptococci (15.6 %), <em>Staphylococcus aureus</em> (10.0 %), and enterococci (12.8 %). Main complications were heart failure (58 %), renal failure (32.8 %), and splenic embolization (35.2 %). Surgery was performed in 83.6 %; overall in-hospital mortality was 25 %; surgical mortality was 21.3 %.</div></div><div><h3>Conclusions</h3><div>Blood culture negative left-sided IE predominated. The mortality rate was high but within the range of reported series. Surgery was performed frequently and patients who were operated on had lower mortality.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 3","pages":"Article 104521"},"PeriodicalIF":3.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143748538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-28DOI: 10.1016/j.bjid.2025.104519
Beatriz Arns , Tarsila Vieceli , Eduardo Gomes , Mariana Horn Scherer , Luisa Nakashima , Maria Luisa Santos , Ronara Blos Hepp , Fernanda Greinert , Maria Helena Rigatto
Introduction
Syphilis is a highly prevalent sexually transmitted infection worldwide. Patients living with Human Immunodeficiency Virus (HIV) have a higher risk of developing neurosyphilis. Actual guidelines advise to proceed with lumbar puncture only if neurologic symptoms are present. However, asymptomatic neurosyphilis patients are not rare in the HIV population and other risk factors should be defined to guide screening.
Methods
We performed a retrospective cohort to evaluate risk factors related to neurosyphilis in HIV patients. Adults with HIV infection and laboratory confirmed syphilis between 2011 and 2021 were included. Patients with no record of syphilis treatment, VDRL titers ≤ 1:4, other neurologic diseases or non-HIV related immunological impairment were excluded. The patients were followed for 2-years after syphilis diagnosis.
Results
One-hundred and forty patients (190 syphilis episodes) were included, with mean age of 45.0 ± 9.2-years-old, 111 (79.3 %) were male, 48 (25.8 %) had CD4 count ≤ 350 cells/mm3 at syphilis diagnosis (median: 522.5 cells/mm3; IQR: 315.5‒703.5), 127 (66.8 %) of 172 had a HIV viral load ≤ 400 copies/mm3 and median serum VDRL titer was 1:64 (IQR: 1:16‒1:128). In multivariate analysis, serum VDRL titers ≥ 1:32 and the presence of neurologic symptoms were associated with neurosyphilis, while HIV viral load ≤ 400 copies/mm3 was a protective factor.
Discussion
In addition to the presence of neurological symptoms, HIV viral load > 400 copies/mm3 and VDRL titers ≥ 1:32 were shown to be risk factors for neurosyphilis in this study and diagnostic lumbar puncture should be considered in these cases.
{"title":"Risk factors for neurosyphilis in HIV patients: A retrospective cohort study","authors":"Beatriz Arns , Tarsila Vieceli , Eduardo Gomes , Mariana Horn Scherer , Luisa Nakashima , Maria Luisa Santos , Ronara Blos Hepp , Fernanda Greinert , Maria Helena Rigatto","doi":"10.1016/j.bjid.2025.104519","DOIUrl":"10.1016/j.bjid.2025.104519","url":null,"abstract":"<div><h3>Introduction</h3><div>Syphilis is a highly prevalent sexually transmitted infection worldwide. Patients living with Human Immunodeficiency Virus (HIV) have a higher risk of developing neurosyphilis. Actual guidelines advise to proceed with lumbar puncture only if neurologic symptoms are present. However, asymptomatic neurosyphilis patients are not rare in the HIV population and other risk factors should be defined to guide screening.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort to evaluate risk factors related to neurosyphilis in HIV patients. Adults with HIV infection and laboratory confirmed syphilis between 2011 and 2021 were included. Patients with no record of syphilis treatment, VDRL titers ≤ 1:4, other neurologic diseases or non-HIV related immunological impairment were excluded. The patients were followed for 2-years after syphilis diagnosis.</div></div><div><h3>Results</h3><div>One-hundred and forty patients (190 syphilis episodes) were included, with mean age of 45.0 ± 9.2-years-old, 111 (79.3 %) were male, 48 (25.8 %) had CD4 count ≤ 350 cells/mm<sup>3</sup> at syphilis diagnosis (median: 522.5 cells/mm<sup>3</sup>; IQR: 315.5‒703.5), 127 (66.8 %) of 172 had a HIV viral load ≤ 400 copies/mm<sup>3</sup> and median serum VDRL titer was 1:64 (IQR: 1:16‒1:128). In multivariate analysis, serum VDRL titers ≥ 1:32 and the presence of neurologic symptoms were associated with neurosyphilis, while HIV viral load ≤ 400 copies/mm<sup>3</sup> was a protective factor.</div></div><div><h3>Discussion</h3><div>In addition to the presence of neurological symptoms, HIV viral load > 400 copies/mm<sup>3</sup> and VDRL titers ≥ 1:32 were shown to be risk factors for neurosyphilis in this study and diagnostic lumbar puncture should be considered in these cases.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 3","pages":"Article 104519"},"PeriodicalIF":3.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-28DOI: 10.1016/j.bjid.2025.104522
Rosa Maria Soares Madeira Domingues , Marcos Augusto Bastos Dias , Ana Paula Esteves Pereira , Paula Mendes Luz , Emilia M. Jalil , Angela Cristina Vasconcelos de Andrade Rabello , Ruth Khalili Friedman , Maria do Carmo Leal
Gestational (GS) and congenital syphilis (CS) are important public health problems in Brazil. This study aims to estimate the prevalence of GS, the incidence of CS and the rate of vertical transmission (VT) of syphilis, as well as to evaluate the management indicators of GS in the State of Rio de Janeiro (RJS), the Brazilian state with the highest detection rate of GS and incidence of CS in 2022. A hospital-based, cross-sectional study was carried out in public and private hospitals located in RJS, in the period 2021–2023, with interviews with 1,923 women, analysis of prenatal care (PNC) cards and hospital records. The GS management indicators, the prevalence of GS, the incidence of CS and the rate of VT were estimated with the respective 95 % confidence intervals (95 % CI), according to the source of financing for hospitalizations for childbirth or abortion care. PNC was reported by 93.7 % of women, 82.7 % had the first test for syphilis and 52.6 % the second. The prevalence of GS was estimated at 14.5 % (95 % CI 9.2 %- 22.2 %), with higher values in women with public financing (18.2 % public; 3.6 % private). Nearly one-third-of women with GS were diagnosed only during hospitalization for childbirth or abortion care and 13.4 % were appropriately treated during PNC. The incidence of CS was estimated at 53.1 per 1,000 live births (68.4 per 1,000 public; 9.7 per 1,000 LB private) with a VT rate of 33.5 %, with no difference according to the source of financing. The detection rate of GS and the incidence rate of CS were double those reported to the Brazilian Notifiable Diseases Information System. Several missed opportunities for the control of CS were identified. Women with public financing had a higher prevalence of GS and incidence of CS, and should be the priority target of control strategies.
{"title":"Gestational and congenital syphilis in the state of Rio de Janeiro, Brazil, 2021‒2023","authors":"Rosa Maria Soares Madeira Domingues , Marcos Augusto Bastos Dias , Ana Paula Esteves Pereira , Paula Mendes Luz , Emilia M. Jalil , Angela Cristina Vasconcelos de Andrade Rabello , Ruth Khalili Friedman , Maria do Carmo Leal","doi":"10.1016/j.bjid.2025.104522","DOIUrl":"10.1016/j.bjid.2025.104522","url":null,"abstract":"<div><div>Gestational (GS) and congenital syphilis (CS) are important public health problems in Brazil. This study aims to estimate the prevalence of GS, the incidence of CS and the rate of vertical transmission (VT) of syphilis, as well as to evaluate the management indicators of GS in the State of Rio de Janeiro (RJS), the Brazilian state with the highest detection rate of GS and incidence of CS in 2022. A hospital-based, cross-sectional study was carried out in public and private hospitals located in RJS, in the period 2021–2023, with interviews with 1,923 women, analysis of prenatal care (PNC) cards and hospital records. The GS management indicators, the prevalence of GS, the incidence of CS and the rate of VT were estimated with the respective 95 % confidence intervals (95 % CI), according to the source of financing for hospitalizations for childbirth or abortion care. PNC was reported by 93.7 % of women, 82.7 % had the first test for syphilis and 52.6 % the second. The prevalence of GS was estimated at 14.5 % (95 % CI 9.2 %- 22.2 %), with higher values in women with public financing (18.2 % public; 3.6 % private). Nearly one-third-of women with GS were diagnosed only during hospitalization for childbirth or abortion care and 13.4 % were appropriately treated during PNC. The incidence of CS was estimated at 53.1 per 1,000 live births (68.4 per 1,000 public; 9.7 per 1,000 LB private) with a VT rate of 33.5 %, with no difference according to the source of financing. The detection rate of GS and the incidence rate of CS were double those reported to the Brazilian Notifiable Diseases Information System. Several missed opportunities for the control of CS were identified. Women with public financing had a higher prevalence of GS and incidence of CS, and should be the priority target of control strategies.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 3","pages":"Article 104522"},"PeriodicalIF":3.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-27DOI: 10.1016/j.bjid.2025.104525
Jing Li , Zeyu Huang , Ruzhi Zhang
Prototheca, an opportunistic pathogenic algae widely found in nature, has emerged as a potential public health concern. Most cases occur in immunocompromised individuals, with infections in immunocompetent patients being relatively rare. Due to their non-specific clinical presentation and limited awareness among clinicians, Prototheca infections are often misdiagnosed, resulting in delayed treatment. Recent advances in species identification and antifungal susceptibility testing have provided important tools for diagnosis and therapy. Here, we report a case of recurrent facial infection in a 76-year-old immunocompetent man. Skin biopsy revealed an infectious granuloma, and fungal culture identified yeast-like colonies. Fluorescence staining and scanning electron microscopy revealed abundant spores, while metagenomic sequencing confirmed the infection as Prototheca wickerhamii. The patient was successfully treated with long-term itraconazole and dipotassium glycyrrhizinate capsules. This case highlights the importance of early and accurate diagnosis in the management of Prototheca skin infections and reviews the therapeutic strategies used.
{"title":"Unmasking Prototheca wickerhamii: A rare case of cutaneous infection and its implications for clinical practice","authors":"Jing Li , Zeyu Huang , Ruzhi Zhang","doi":"10.1016/j.bjid.2025.104525","DOIUrl":"10.1016/j.bjid.2025.104525","url":null,"abstract":"<div><div><em>Prototheca</em>, an opportunistic pathogenic algae widely found in nature, has emerged as a potential public health concern. Most cases occur in immunocompromised individuals, with infections in immunocompetent patients being relatively rare. Due to their non-specific clinical presentation and limited awareness among clinicians, <em>Prototheca</em> infections are often misdiagnosed, resulting in delayed treatment. Recent advances in species identification and antifungal susceptibility testing have provided important tools for diagnosis and therapy. Here, we report a case of recurrent facial infection in a 76-year-old immunocompetent man. Skin biopsy revealed an infectious granuloma, and fungal culture identified yeast-like colonies. Fluorescence staining and scanning electron microscopy revealed abundant spores, while metagenomic sequencing confirmed the infection as <em>Prototheca wickerhamii</em>. The patient was successfully treated with long-term itraconazole and dipotassium glycyrrhizinate capsules. This case highlights the importance of early and accurate diagnosis in the management of <em>Prototheca</em> skin infections and reviews the therapeutic strategies used.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 3","pages":"Article 104525"},"PeriodicalIF":3.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143706506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-26DOI: 10.1016/j.bjid.2025.104518
Taniela Marli Bes , Robson Eduardo Soares , Roberta Ruedas Martins , Lauro Perdigao-Neto , Diego Mongelos , Luisa Moreno , Andrea Moreno , Gerson Salvador de Oliveira , Silvia Figueiredo Costa , Anna Sara Levin
Methicillin-Resistant Staphylococcus Aureus (MRSA) is commonly transmitted among hospitalized patients through direct contact or contaminated objects. However, the dynamics of household transmission of MRSA remain unclear, posing challenges for effective prevention. This study evaluates the persistence of MRSA colonization in asymptomatic carriers over a period of at least 17-months and examines the potential for intra-household transmission. We conducted home visits to seven families, each with at least one MRSA-colonized member, to collect nasal swabs from all household members. Phenotypic and genotypic profiles of the isolates were determined through culture, antimicrobial susceptibility testing, and PCR. We compared these new samples with previous samples from a recent study involving the same individuals to assess spontaneous clearance of MRSA. A total of 25 samples were collected, with 56 % (14) identified as S. aureus and 44 % (11) as non-S. aureus; among the S. aureus isolates, four were MRSA. We observed spontaneous clearance of MRSA in six of the original cases. Unexpectedly, there was limited intra-household transmission of MRSA, although all families with MRSA colonization had at least one member with a history of skin disease. In the family where colonization persisted, one individual had recurrent cutaneous abscesses, suggesting a possible link to sustained colonization.
{"title":"Evaluating long-term MRSA colonization and household spread: Insights from a community-based study","authors":"Taniela Marli Bes , Robson Eduardo Soares , Roberta Ruedas Martins , Lauro Perdigao-Neto , Diego Mongelos , Luisa Moreno , Andrea Moreno , Gerson Salvador de Oliveira , Silvia Figueiredo Costa , Anna Sara Levin","doi":"10.1016/j.bjid.2025.104518","DOIUrl":"10.1016/j.bjid.2025.104518","url":null,"abstract":"<div><div>Methicillin-Resistant <em>Staphylococcus Aureus</em> (MRSA) is commonly transmitted among hospitalized patients through direct contact or contaminated objects. However, the dynamics of household transmission of MRSA remain unclear, posing challenges for effective prevention. This study evaluates the persistence of MRSA colonization in asymptomatic carriers over a period of at least 17-months and examines the potential for intra-household transmission. We conducted home visits to seven families, each with at least one MRSA-colonized member, to collect nasal swabs from all household members. Phenotypic and genotypic profiles of the isolates were determined through culture, antimicrobial susceptibility testing, and PCR. We compared these new samples with previous samples from a recent study involving the same individuals to assess spontaneous clearance of MRSA. A total of 25 samples were collected, with 56 % (14) identified as <em>S. aureus</em> and 44 % (11) as non-S. aureus; among the <em>S. aureus</em> isolates, four were MRSA. We observed spontaneous clearance of MRSA in six of the original cases. Unexpectedly, there was limited intra-household transmission of MRSA, although all families with MRSA colonization had at least one member with a history of skin disease. In the family where colonization persisted, one individual had recurrent cutaneous abscesses, suggesting a possible link to sustained colonization.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 2","pages":"Article 104518"},"PeriodicalIF":3.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-24DOI: 10.1016/j.bjid.2025.104517
Jorge Alberto Cortés , Diego Andrés Rodríguez-Lugo , Martha Carolina Valderrama-Rios , Ricardo Rabagliati , Domenico Capone , Carlos Arturo Álvarez-Moreno , Fabio Varón-Vega , Laura Cristina Nocua-Báez , Cándida Diaz-Brochero , Leonardo Enciso Olivera , Sonia Isabel Cuervo-Maldonado , Luis Thompson , Dora E. Corzo-León , Luis E. Cuéllar , Erika Paola Vergara , Fernando Riera , Patricia Cornejo-Juárez , Rita Rojas , Beatriz L. Gómez , Adriana Marcela Celis-Ramírez , Marcio Nucci
Aspergillosis is a disease caused by the filamentous fungus Aspergillus spp. with a spectrum of clinical presentation that includes invasive and noninvasive forms. The invasive clinical presentation of aspergillosis most frequently affects people with compromised immune systems. In patients with oncohematologic pathology, invasive lung aspergillosis is a significant opportunistic mycosis, because it occurs frequently and has a major impact on morbidity, mortality, and high costs. The global problem of antimicrobial resistance, to which improper use of antifungals contributes, has put Aspergilus spp. in the spotlight, so it is important to generate guidelines for guidance in the proper use of antifungals in the management of invasive lung aspergillosis, to obtain better clinical outcomes and promote rational use of antifungals. This guideline contains recommendations for diagnosing and treating invasive lung aspergillosis in patients with oncohematologic disease, based on evidence and defined through a participatory process of expert consensus, for the Latin American context.
{"title":"Evidence-based clinical standard for the diagnosis and treatment of invasive lung aspergillosis in the patient with oncohematologic disease","authors":"Jorge Alberto Cortés , Diego Andrés Rodríguez-Lugo , Martha Carolina Valderrama-Rios , Ricardo Rabagliati , Domenico Capone , Carlos Arturo Álvarez-Moreno , Fabio Varón-Vega , Laura Cristina Nocua-Báez , Cándida Diaz-Brochero , Leonardo Enciso Olivera , Sonia Isabel Cuervo-Maldonado , Luis Thompson , Dora E. Corzo-León , Luis E. Cuéllar , Erika Paola Vergara , Fernando Riera , Patricia Cornejo-Juárez , Rita Rojas , Beatriz L. Gómez , Adriana Marcela Celis-Ramírez , Marcio Nucci","doi":"10.1016/j.bjid.2025.104517","DOIUrl":"10.1016/j.bjid.2025.104517","url":null,"abstract":"<div><div>Aspergillosis is a disease caused by the filamentous fungus <em>Aspergillus</em> spp. with a spectrum of clinical presentation that includes invasive and noninvasive forms. The invasive clinical presentation of aspergillosis most frequently affects people with compromised immune systems. In patients with oncohematologic pathology, invasive lung aspergillosis is a significant opportunistic mycosis, because it occurs frequently and has a major impact on morbidity, mortality, and high costs. The global problem of antimicrobial resistance, to which improper use of antifungals contributes, has put <em>Aspergilus</em> spp. in the spotlight, so it is important to generate guidelines for guidance in the proper use of antifungals in the management of invasive lung aspergillosis, to obtain better clinical outcomes and promote rational use of antifungals. This guideline contains recommendations for diagnosing and treating invasive lung aspergillosis in patients with oncohematologic disease, based on evidence and defined through a participatory process of expert consensus, for the Latin American context.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 2","pages":"Article 104517"},"PeriodicalIF":3.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-22DOI: 10.1016/j.bjid.2025.104516
Ahmet Melih Şahin, Emrullah Ataş, Sinan Çetin
Crimean-Congo Hemorrhagic Fever (CCHF) is a viral hemorrhagic fever common in many regions of the world. There are many diseases in the differential diagnosis of CCHF. In our study, we aimed to predict the diagnosis of CCHF at the time of initial presentation by using clinical and laboratory findings in patients with a preliminary diagnosis of CCHF. In our study, 74 patients with a definitive diagnosis of CCHF and 43 patients with a preliminary diagnosis of CCHF but not diagnosed with CCHF were compared in terms of demographic, clinical and laboratory findings. Multivariate logistic regression analysis and Receiver Operating Characteristics (ROC) curve were used to determine variables to predict the diagnosis of CCHF. Living in an endemic area, tick bite, fever, CRP below 48 mg/L and PCT below 0.52 ng/mL were determined as independent risk factors for CCHF diagnosis. The specificity for cut off values of 2485 mm3 for WBC and 970 mm3 for neutrophil count were 86 % and 93 %, respectively. The sensitivity for cut off values of 48 mg/L for CRP and 0.52 ng/mL for PCT were 90.5 % and 82.4 %, respectively. In-hospital and 28-day mortality were higher in the non-CCHF group. The differential diagnosis of CCHF is important for planning appropriate isolation procedures and treatments for patients. Additionally, by excluding CCHF, it allows for the early consideration of other diseases in the non-CCHF group that show high mortality. In patients living in endemic areas with tick bites and clinical findings compatible with CCHF, easily accessible tests such as WBC, neutrophil count, CRP and PCT, within the cut-off values identified in our study, will assist in diagnosing CCHF at the initial presentation.
{"title":"Crimean-Congo hemorrhagic fever: Strategies for diagnosis at initial admission","authors":"Ahmet Melih Şahin, Emrullah Ataş, Sinan Çetin","doi":"10.1016/j.bjid.2025.104516","DOIUrl":"10.1016/j.bjid.2025.104516","url":null,"abstract":"<div><div>Crimean-Congo Hemorrhagic Fever (CCHF) is a viral hemorrhagic fever common in many regions of the world. There are many diseases in the differential diagnosis of CCHF. In our study, we aimed to predict the diagnosis of CCHF at the time of initial presentation by using clinical and laboratory findings in patients with a preliminary diagnosis of CCHF. In our study, 74 patients with a definitive diagnosis of CCHF and 43 patients with a preliminary diagnosis of CCHF but not diagnosed with CCHF were compared in terms of demographic, clinical and laboratory findings. Multivariate logistic regression analysis and Receiver Operating Characteristics (ROC) curve were used to determine variables to predict the diagnosis of CCHF. Living in an endemic area, tick bite, fever, CRP below 48 mg/L and PCT below 0.52 ng/mL were determined as independent risk factors for CCHF diagnosis. The specificity for cut off values of 2485 mm<sup>3</sup> for WBC and 970 mm<sup>3</sup> for neutrophil count were 86 % and 93 %, respectively. The sensitivity for cut off values of 48 mg/L for CRP and 0.52 ng/mL for PCT were 90.5 % and 82.4 %, respectively. In-hospital and 28-day mortality were higher in the non-CCHF group. The differential diagnosis of CCHF is important for planning appropriate isolation procedures and treatments for patients. Additionally, by excluding CCHF, it allows for the early consideration of other diseases in the non-CCHF group that show high mortality. In patients living in endemic areas with tick bites and clinical findings compatible with CCHF, easily accessible tests such as WBC, neutrophil count, CRP and PCT, within the cut-off values identified in our study, will assist in diagnosing CCHF at the initial presentation.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 2","pages":"Article 104516"},"PeriodicalIF":3.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.bjid.2025.104512
Geane Flores , Barbara Vieira Lago , Amanda R Caetano , Jessica Silva , Vanessa Marques , Carlos Eduardo Brandão-Mello , Marcia Amendola-Pires , Jose Pilotto , Lia Lewis-Ximenez , Livia Melo Villar
Background
Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) share the same routes of transmission, therefore, co-infection by both viruses represents a challenge to the goal of eliminating viral hepatitis as a public health threat. There are an estimated 2.3 million people living with HIV/HCV worldwide. Most of these cases affect vulnerable populations located in places with low infrastructure. Because of this, the use of alternative samples such as Dried Blood on Spot (DBS) would facilitate access to diagnosis and HCV treatment. The aim of this study is to evaluate the HCV genetic variability in HIV/HCV individuals by correlating paired serum and DBS samples.
Methods
A total of 14 HIV/HCV individuals, recruited from reference outpatient clinics in the city of Rio de Janeiro/Brazil, were included. From them, 64 % were man, mean of age 54±7. HCV RNA from both serum and DBS samples was RT-PCR amplified and sequenced with HCV NS5B-specific oligonucleotides. All positive samples were submitted to phylogenetic analysis.
Results
Serum mean HCV load was 6.2 ± 0.5 log IU/mL. All patients presented undetectable HIV RNA. The distribution of HCV genotypes/subgenotypes was 1a (4/14); 1b (5/14); 3a (4/14); and 4d (1/14). Most paired serum and DBS samples showed concordant results (genetic distance: 0.0 to 0.16). One individual showed discordance in the subtypes between serum and DBS. Three individuals presented the 316 N Resistance Associated Mutation (RAS) in both serum and DBS.
Conclusion
Our results demonstrate the applicability of DBS for HCV molecular tracking in HIV/HCV coinfected patients for viral genomic surveillance in key and vulnerable populations.
{"title":"Dried blood spot as alternative specimen for molecular epidemiology studies among HCV/HIV coinfected patients","authors":"Geane Flores , Barbara Vieira Lago , Amanda R Caetano , Jessica Silva , Vanessa Marques , Carlos Eduardo Brandão-Mello , Marcia Amendola-Pires , Jose Pilotto , Lia Lewis-Ximenez , Livia Melo Villar","doi":"10.1016/j.bjid.2025.104512","DOIUrl":"10.1016/j.bjid.2025.104512","url":null,"abstract":"<div><h3>Background</h3><div>Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) share the same routes of transmission, therefore, co-infection by both viruses represents a challenge to the goal of eliminating viral hepatitis as a public health threat. There are an estimated 2.3 million people living with HIV/HCV worldwide. Most of these cases affect vulnerable populations located in places with low infrastructure. Because of this, the use of alternative samples such as Dried Blood on Spot (DBS) would facilitate access to diagnosis and HCV treatment. The aim of this study is to evaluate the HCV genetic variability in HIV/HCV individuals by correlating paired serum and DBS samples.</div></div><div><h3>Methods</h3><div>A total of 14 HIV/HCV individuals, recruited from reference outpatient clinics in the city of Rio de Janeiro/Brazil, were included. From them, 64 % were man, mean of age 54±7. HCV RNA from both serum and DBS samples was RT-PCR amplified and sequenced with HCV NS5B-specific oligonucleotides. All positive samples were submitted to phylogenetic analysis.</div></div><div><h3>Results</h3><div>Serum mean HCV load was 6.2 ± 0.5 log IU/mL. All patients presented undetectable HIV RNA. The distribution of HCV genotypes/subgenotypes was 1a (4/14); 1b (5/14); 3a (4/14); and 4d (1/14). Most paired serum and DBS samples showed concordant results (genetic distance: 0.0 to 0.16). One individual showed discordance in the subtypes between serum and DBS. Three individuals presented the 316 N Resistance Associated Mutation (RAS) in both serum and DBS.</div></div><div><h3>Conclusion</h3><div>Our results demonstrate the applicability of DBS for HCV molecular tracking in HIV/HCV coinfected patients for viral genomic surveillance in key and vulnerable populations.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 2","pages":"Article 104512"},"PeriodicalIF":3.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.bjid.2025.104515
Wilson Toyohiro Hoshino , Adriana Maria Paixão De Sousa da Silva , Antonio Carlos Pignatari , Ana Cristina Gales , Fabianne Carlesse
Background
Ceftazidime-Avibactam (CAZ-AVI) plays a key role in the treatment of Multidrug Resistant Gram-Negative Bacilli (MDR-GNB) infections. In pediatrics, CAZ-AVI is clinically approved for treatment of urinary tract or intra-abdominal infection. However, there is limited data available about its use in children with cancer who have complicated infections caused by MDR-GNB.
Objective
This study aims to describe our experience in using CAZ-AVI for the treatment of MDR GNB infections in children with cancer.
Methods
This retrospective observational study was conducted at the Pediatric Oncology Institute (IOP/GRAACC/UNIFESP), including pediatric oncologic patients who received CAZ-AVI for the treatment of infections caused by GNB.
Results
From Jan/2021 to Jun/2022, 11 patients with 13 episodes were included in the analysis. Among them, 45 % were female, with a median age of 7 years. Three patients had Acute lymphoblastic Leukemia (ALL), three had Acute Myeloid Leukemia (AML), two had Non-Hodgkin Lymphoma (NHL). Additionally, there was one case each of medulloblastoma, fibrosarcoma, and craniopharyngioma. All patients presented significant risk factors for MDR-GNB, such as neutropenia and two were submitted to Hematopoietic Stem Cell Transplantation (HSCT). The infection episodes included six Bloodstream Infections (BSI), two Urinary Tract Infections (UTI), two tracheobronchitis cases, along with one case each of necrotizing pneumonia, ventriculitis, and endocarditis. The identified pathogens included Klebsiella pneumoniae, Pseudomonas spp., Enterobacter cloacae, and Stenotrophomonas maltophilia. The primary reason for prescribing CAZ-AVI was either Multidrug-Resistant Gram-Negative Bacteria (MDR-GNB) infection or clinical worsening after initial therapy. Combination therapy was prescribed in eight episodes with a median prescription length of nine days. Microbiological sterilization was achieved in 92 % of episodes, and the 30-day survival rate was 84 %. Notably, no deaths were associated with treatment failure, and no adverse events associated with CAZ-AVI use were observed.
Conclusion
CAZ-AVI could be used for treating GNB infections in oncologic pediatric patients.
{"title":"Experience in Ceftazidime-Avibactam for treatment of MDR BGN infection in Oncologic Children","authors":"Wilson Toyohiro Hoshino , Adriana Maria Paixão De Sousa da Silva , Antonio Carlos Pignatari , Ana Cristina Gales , Fabianne Carlesse","doi":"10.1016/j.bjid.2025.104515","DOIUrl":"10.1016/j.bjid.2025.104515","url":null,"abstract":"<div><h3>Background</h3><div>Ceftazidime-Avibactam (CAZ-AVI) plays a key role in the treatment of Multidrug Resistant Gram-Negative Bacilli (MDR-GNB) infections. In pediatrics, CAZ-AVI is clinically approved for treatment of urinary tract or intra-abdominal infection. However, there is limited data available about its use in children with cancer who have complicated infections caused by MDR-GNB.</div></div><div><h3>Objective</h3><div>This study aims to describe our experience in using CAZ-AVI for the treatment of MDR GNB infections in children with cancer.</div></div><div><h3>Methods</h3><div>This retrospective observational study was conducted at the Pediatric Oncology Institute (IOP/GRAACC/UNIFESP), including pediatric oncologic patients who received CAZ-AVI for the treatment of infections caused by GNB.</div></div><div><h3>Results</h3><div>From Jan/2021 to Jun/2022, 11 patients with 13 episodes were included in the analysis. Among them, 45 % were female, with a median age of 7 years. Three patients had Acute lymphoblastic Leukemia (ALL), three had Acute Myeloid Leukemia (AML), two had Non-Hodgkin Lymphoma (NHL). Additionally, there was one case each of medulloblastoma, fibrosarcoma, and craniopharyngioma. All patients presented significant risk factors for MDR-GNB, such as neutropenia and two were submitted to Hematopoietic Stem Cell Transplantation (HSCT). The infection episodes included six Bloodstream Infections (BSI), two Urinary Tract Infections (UTI), two tracheobronchitis cases, along with one case each of necrotizing pneumonia, ventriculitis, and endocarditis. The identified pathogens included <em>Klebsiella pneumoniae, Pseudomonas spp</em>., <em>Enterobacter cloacae</em>, and <em>Stenotrophomonas maltophilia</em>. The primary reason for prescribing CAZ-AVI was either Multidrug-Resistant Gram-Negative Bacteria (MDR-GNB) infection or clinical worsening after initial therapy. Combination therapy was prescribed in eight episodes with a median prescription length of nine days. Microbiological sterilization was achieved in 92 % of episodes, and the 30-day survival rate was 84 %. Notably, no deaths were associated with treatment failure, and no adverse events associated with CAZ-AVI use were observed.</div></div><div><h3>Conclusion</h3><div>CAZ-AVI could be used for treating GNB infections in oncologic pediatric patients.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 2","pages":"Article 104515"},"PeriodicalIF":3.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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