Brazilian Journal of Infectious Diseases最新文献_第5页

COVID-19 hospitalization in vaccinated and non-vaccinated patients: Clinical profile and outcomes 接种疫苗和未接种疫苗患者的COVID-19住院：临床概况和结果

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-05-01 DOI: 10.1016/j.bjid.2025.104537

Laura Holtman-Ferreira , Elessandra de Souza Bitencourt , Betina Mendez de Alcantara Gabardo , Susanne Edinger Pereira , Francine Teixeira , Diego da Silva Magatão , Vitor Loureiro Dias , Ricardo Petterle , Meri Bordignon Nogueira , Sonia Mara Raboni

COVID-19, caused by SARS-CoV-2 infection, left widespread impacts worldwide. In Brazil, immunization reduced incidence rates. However, six months later, waning neutralizing antibody titers and new immune-evading variants increased cases, resulting in recurring waves. This study evaluated hospitalized COVID-19 patients after the vaccination rollout, comparing the clinical outcomes between vaccinated and unvaccinated patients. Positive samples underwent nucleotide sequencing. A total of 218 patients were included; 202 (92 %) had vaccination data, 98 received at least one dose, and 64 completed the vaccination schedule, predominantly with CoronaVac®. Vaccinated individuals were older on average since the campaign was primarily conducted among the elderly. The Gamma variant predominated during the study period. While not statistically significant, trends indicated greater respiratory assistance needs, more extended hospital stays, and increased ICU time among unvaccinated patients. Mortality was 45 % in vaccinated and 37 % in unvaccinated groups, with no notable difference. However, patients with a complete vaccination schedule showed a higher chance of survival, though not significant (p = 0.11). The factors significantly associated with higher mortality were older patients, those requiring vasopressor drugs, and mechanical ventilation. These findings provide clinical, epidemiological, and phylogenetic insights into COVID-19 patients during vaccination implementation. They underscore the need to evaluate vaccine effectiveness against circulating variants and highlight the importance of complete vaccination schedules for improving patient outcomes.

由SARS-CoV-2感染引起的COVID-19在世界范围内造成了广泛影响。在巴西，免疫接种降低了发病率。然而，六个月后，减弱的中和抗体滴度和新的免疫逃避变体增加了病例，导致反复出现的波浪。本研究评估了疫苗接种后住院的COVID-19患者，比较了接种疫苗和未接种疫苗患者的临床结果。阳性样本进行核苷酸测序。共纳入218例患者；202例（92%）有疫苗接种数据，98例至少接种了一剂，64例完成了疫苗接种计划，主要是CoronaVac®。接种疫苗的人平均年龄较大，因为该运动主要在老年人中进行。在研究期间，伽玛变体占主导地位。虽然没有统计学意义，但趋势表明，未接种疫苗的患者更需要呼吸辅助，住院时间更长，ICU时间更长。接种疫苗组的死亡率为45%，未接种疫苗组的死亡率为37%，无显著差异。然而，接种完整疫苗计划的患者生存率更高，但不显著（p = 0.11）。与高死亡率显著相关的因素是老年患者、需要血管加压药物和机械通气的患者。这些发现为接种疫苗期间的COVID-19患者提供了临床、流行病学和系统发育方面的见解。他们强调需要评估疫苗对流行变体的有效性，并强调完整的疫苗接种计划对改善患者预后的重要性。

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引用次数: 0

Disseminated bartonellosis and EBV reactivation in an adolescent treated with upadacitinib 用upadacitinib治疗的青少年弥散性巴尔通体病和EBV再激活

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-05-01 DOI: 10.1016/j.bjid.2025.104536

Vincent Pargny , Emilie Delugre , Raphael Janela , Soumaya Skalli , Abdeljalil Zeggay , Hortense Petat

Background

Bartonella henselae is responsible for disseminated infections in immunocompromised patients. Upadacitinib is a JAK inhibitor used since 2021 for the treatment of severe atopic dermatitis in adolescents over 12-years. We report here the case of disseminated Bartonellosis in a 15-year-old male treated with upadacitinib.

Case presentation

This patient presented with fever and abdominal pain. Laboratory tests showed inflammation, rhabdomyolysis and acute renal failure. Imaging studies revealed lymphadenopathies, hepatosplenic, renal and pulmonary nodules, pleural and peritoneal effusions and spleen abscesses. Bartonella henselae serology was positive for IgG and IgM. Treatment with doxycycline resolved the symptoms. We detected a concomitant EBV reactivation.

Conclusions

Bartonella henselae infection should be suspected in immunocompromised patients presenting with fever of unknown origin. Upadacitinib is responsible for rapid immunodepression, which can lead to viral reactivation and severe bacterial infections. Randomized controlled trials are needed to establish a consensus on treatments for the various forms of Bartonellosis.

背景：亨塞拉巴尔通体是免疫功能低下患者播散性感染的原因。Upadacitinib是一种JAK抑制剂，自2021年起用于治疗12岁以上青少年的严重特应性皮炎。我们在这里报告的病例播散巴尔通体病在一个15岁的男性与upadacitinib治疗。病例表现：患者表现为发热和腹痛。实验室检查显示有炎症、横纹肌溶解和急性肾功能衰竭。影像学检查显示淋巴结病变、肝脾、肾和肺结节、胸膜和腹膜积液和脾脓肿。母鸡巴尔通体血清IgG和IgM阳性。多西环素治疗可缓解症状。我们检测到伴随的EBV再激活。结论出现不明原因发热的免疫功能低下患者应怀疑为亨塞巴尔通体感染。Upadacitinib负责快速免疫抑制，这可能导致病毒再激活和严重的细菌感染。需要进行随机对照试验，以就各种形式巴尔通体病的治疗方法达成共识。

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引用次数: 0

Real-world accuracy of SARS-CoV-2 antigen detection compared with qPCR: A cross-sectional study in Toledo - PR, Brazil 与qPCR相比，SARS-CoV-2抗原检测的真实世界准确性：巴西托莱多- PR的横断面研究

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-04-17 DOI: 10.1016/j.bjid.2025.104520

Carla Adriane Royer , Regis Goulart Rosa , Maicon Falavigna , Jaqueline Carvalho de Oliveira

Rapid Antigen Tests (Ag-RDTs) for the detection of SARS-CoV-2 is an important diagnostic tool for containing virus spread. However, their accuracy ‒ the proportion of correct results (both true positives and true negatives) ‒ still needs to be proven when used in a real large-scale context. Accordingly, we provide data from a cross-sectional study conducted in Toledo - PR, Brazil, on the accuracy of rapid tests compared with qPCR within the Brazilian Unified Health System. A total of 2882 thousand individuals presenting symptoms suggestive of COVID-19 were screened. Overall, the antigen tests showed a sensitivity, specificity, and accuracy of 59 % (0.56‒0.62), 99 % (0.98‒0.99), and 82 % (0.81‒0.84) respectively. However, a significant difference was found when analysing two brand tests individually. In addition, for patients with a low quantification Cycle (Cq) < 20 (which indicates a high viral load), the agreement between test results was high (90.85 %). However, this agreement decreased significantly when the viral load decreased, dropping to 5.59 % for samples with Cq ≥ 33, which indicates a lower viral load. While rapid antigen tests are a valuable tool in combating virus spread, their accuracy can vary significantly between manufacturers and under conditions of low viral load.

检测SARS-CoV-2的快速抗原试验（Ag-RDTs）是遏制病毒传播的重要诊断工具。然而，它们的准确性——正确结果的比例（包括真阳性和真阴性）——仍然需要在真正的大规模环境中得到证明。因此，我们提供了在巴西托莱多- PR进行的横断面研究的数据，比较了巴西统一卫生系统内快速检测与qPCR的准确性。总共筛查了28.2万名出现COVID-19症状的人。总体而言，抗原检测的敏感性、特异性和准确性分别为59%（0.56-0.62）、99%（0.98-0.99）和82%（0.81-0.84）。然而，当分别分析两个品牌测试时，发现了显著的差异。此外，对于量化周期（Cq） <；20（表明病毒载量高），检测结果之间的一致性很高（90.85%）。然而，当病毒载量降低时，这种一致性显著降低，Cq≥33的样本下降到5.59%，表明病毒载量较低。虽然快速抗原检测是对抗病毒传播的宝贵工具，但其准确性在不同制造商和低病毒载量条件下可能有很大差异。

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引用次数: 0

Increased rates of blaNDM in Pseudomonas aeruginosa in a tertiary care hospital in southern Brazil 在巴西南部的三级保健医院铜绿假单胞菌的白粉病发病率增加

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-04-10 DOI: 10.1016/j.bjid.2025.104523

Patricia Orlandi Barth , Dariane Castro Pereira , Camila Mörschbächer Wilhelm , Kellen Figueira Tragnago , Afonso Luís Barth

Carbapenem-Resistant Pseudomonas Aeruginosa (CRPA) is considered as one of the high priority pathogens by the World Health Organization. As CRPA carbapenemase producers have increased worldwide, the aim of this study was to evaluate the carbapenemase prevalence in CRPA at a tertiary care hospital in Brazil”. All 395 CRPA identified in the period of September 2021 to May 2024 were evaluated by multiplex real-time polymerase chain reaction (qPCR-HRM) for the following carbapenemase genes: bla_KPC, bla_NDM, bla_OXA-48-like, bla_IMP, bla_VIM, bla_SPM and bla_GES. In the first period analyzed (September to December 2021), almost 70 % of the isolates were negative for the 7 tested genes, and the bla_NDM was found in 27.3 % of the CRPA. In the following semesters there was an increase of bla_NDM as follows: January to June of 2022 = 29.8 %; July to December of 2022 = 43.8 %; January to June of 2023 = 42.4 %; July to December 2023 = 58.9 % and January to May of 2024 = 59.5 % of bla_NDM. The prevalence of the other carbapenemases remained low. These results indicated an important increase of the bla_NDM gene, overcoming the CRPA non-carbapenemase producers in our institution.

耐碳青霉烯铜绿假单胞菌（CRPA）是世界卫生组织认定的重点防治病原菌之一。随着CRPA碳青霉烯酶生产商在全球范围内的增加，本研究的目的是评估巴西一家三级保健医院CRPA中碳青霉烯酶的流行情况。采用多重实时聚合酶链反应（qPCR-HRM）对2021年9月至2024年5月期间鉴定的395个CRPA进行碳青霉烯酶基因：blaKPC、blaNDM、blaOXA-48-like、blaIMP、blaVIM、blaSPM和blaGES的评估。在第一个分析时期（2021年9月至12月），近70%的分离株对7个检测基因呈阴性，其中27.3%的CRPA中发现了blaNDM。在接下来的学期中，blaNDM的增长如下：2022年1月至6月= 29.8%；2022年7月至12月= 43.8%；2023年1月至6月= 42.4%；2023年7月至12月= 58.9%，2024年1月至5月= 59.5%。其他碳青霉烯酶的流行率仍然很低。这些结果表明blaNDM基因的重要增加，克服了我们机构的CRPA非碳青霉烯酶生产者。

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引用次数: 0

Tuberculosis parenteral therapeutic regimens for critical patients or non-functional intestinal tract: Brief review and proposal of protocol 危重患者或非功能性肠道的结核肠外治疗方案：简要回顾和方案建议

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-04-07 DOI: 10.1016/j.bjid.2025.104526

Antonio Camargo Martins , Márcia Teixeira Garcia , Mariângela Ribeiro Resende

Standard anti-tuberculosis regimens (Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol [RHZE]) remain challenging for critically ill patients and those with a non-functioning gastrointestinal tract. In Brazil, these challenges are amplified by the lack of Intravenous (IV) rifampicin, isoniazid, and ethambutol, which often results in suboptimal outcomes. This brief communication synthesized evidence on parenteral therapies and proposed a structured, five-step protocol for critically ill patients unable to receive oral drugs. A narrative review of the guidelines and key studies was also conducted. IV formulations of RHZE are approved in only some countries and are not available everywhere. Alternative IV drug classes, such as fluoroquinolones, aminoglycosides, carbapenems, and oxazolidinones, can address malabsorption or intolerance to oral RHZE. However, no standardized regimen exists for this population. Our five-step protocol advises: (1) Characterizing each TB case, (2) determining IV necessity, (3) Consulting specialized TB services, (4) Designing a safe and effective regimen, and (5) Re-evaluating therapy for transition to oral treatment. Given the morbidity and mortality from severe TB in Intensive Care Units (ICU), a formalized approach is essential. Further research and policy initiatives regarding IV first-line drugs are crucial to improve treatment outcomes in this vulnerable group. This strategy unifies practice across diverse clinical settings.

标准抗结核方案（利福平、异烟肼、吡嗪酰胺和乙胺丁醇[RHZE]）对危重患者和胃肠道功能障碍患者仍然具有挑战性。在巴西，由于缺乏静脉注射（IV）利福平、异烟肼和乙胺丁醇，这些挑战被放大，往往导致不理想的结果。这份简短的报告综合了肠外治疗的证据，并为无法接受口服药物的危重患者提出了一个结构化的五步方案。还对准则和主要研究进行了叙述性审查。RHZE的静脉制剂仅在一些国家获得批准，并不是在所有地方都可以获得。其他IV类药物，如氟喹诺酮类、氨基糖苷类、碳青霉烯类和恶唑烷酮类，可解决口服RHZE吸收不良或不耐受的问题。然而，没有针对这一人群的标准化治疗方案。我们的五步方案建议：(1)确定每个结核病病例的特征，(2)确定静脉注射的必要性，(3)咨询专门的结核病服务，(4)设计安全有效的方案，(5)重新评估治疗是否过渡到口服治疗。鉴于重症监护病房（ICU）重症结核病的发病率和死亡率，一种正式的方法至关重要。关于静脉注射一线药物的进一步研究和政策举措对于改善这一弱势群体的治疗结果至关重要。这一策略统一了不同临床环境的实践。

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引用次数: 0

Gas-forming abscess associated with prosthetic vascular graft infection caused by Bacteroides fragilis 由脆弱拟杆菌引起的假体血管感染相关的气性脓肿

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-04-02 DOI: 10.1016/j.bjid.2025.104524

Motoshi Iwao , Takehiro Hashimoto , Ryota Tanaka , Kazufumi Hiramatsu , Hiroki Itoh

Introduction

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.

摘要假体血管感染是腹主动脉瘤开腹修复术中一种罕见但严重的并发症。我们报告一例由脆弱拟杆菌引起的与PVGI相关的气体形成脓肿，从引流液和血液培养中鉴定出来。病例介绍一名67岁男性，主诉腰痛加重，因腹主动脉瘤接受了紧急开放手术。术后第18天，腹部CT显示动脉瘤内形成气体。引流液的革兰氏染色显示革兰氏阴性杆状体，对鉴定为脆弱芽孢杆菌的液体进行16S rRNA基因测序，尽管培养液为阴性。由厌氧细菌如拟杆菌引起的PVGI是比较罕见的。16S rRNA基因测序对培养阴性标本的敏感性一般较低，但革兰氏染色标本阳性时，16S rRNA测序阳性率升高。

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引用次数: 0

Contemporary cohort study in adult patients with infective endocarditis 成人感染性心内膜炎的当代队列研究

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-04-02 DOI: 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.

背景：有效性心内膜炎（IE）是一种严重的疾病，发病率和死亡率都很高。很少有案例系列来自中等收入国家。我们的目的是描述在巴西参考中心治疗的IE患者的病例系列，并与其他国家的数据进行比较。方法回顾性分析一项前瞻性实施的心内膜炎数据库，包括2006年1月至2023年6月确诊的成人IE患者。进行了文献检索和总结。使用Jamovi®1.2.2版本进行统计分析。结果IE发作502次；平均年龄±SD为48.4±17.2岁。社区获得性IE发生率为64.7%。主要易感性为风湿性瓣膜病（30.7%）、假体（31.5%）和先天性心脏病（13.9%）。经胸和经食管超声心动图分别为85%和78%。左侧IE占优。发热占90.6%，新发杂音占50.7%，栓塞占45%。33.1%血培养阴性；常见病原菌为口腔链球菌（15.6%）、金黄色葡萄球菌（10.0%）和肠球菌（12.8%）。主要并发症为心力衰竭（58%）、肾衰竭（32.8%）和脾栓塞（35.2%）。手术成功率为83.6%；总体住院死亡率为25%；手术死亡率为21.3%。结论左侧IE以血培养阴性为主。死亡率高，但在报告系列的范围内。手术频繁，手术患者死亡率较低。

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引用次数: 0

Risk factors for neurosyphilis in HIV patients: A retrospective cohort study HIV患者神经梅毒的危险因素：一项回顾性队列研究

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-03-28 DOI: 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.

梅毒是世界范围内高度流行的性传播感染。患有人类免疫缺陷病毒（HIV）的患者患神经梅毒的风险较高。实际指南建议只有在出现神经系统症状时才进行腰椎穿刺。然而，无症状神经梅毒患者在HIV人群中并不罕见，需要明确其他危险因素来指导筛查。方法回顾性分析HIV患者神经梅毒的相关危险因素。纳入了2011年至2021年间感染艾滋病毒和实验室确诊梅毒的成年人。排除无梅毒治疗记录、VDRL滴度≤1:4、其他神经系统疾病或非hiv相关免疫功能障碍患者。确诊后随访2年。结果纳入140例梅毒患者（190例），平均年龄45.0±9.2岁，男性111例（79.3%），梅毒诊断时CD4细胞计数≤350细胞/mm3 48例（25.8%）(中位数：522.5细胞/mm3；IQR: 315.5-703.5)，其中127例（66.8%）的HIV病毒载量≤400拷贝/mm3，血清VDRL滴度中位数为1:64 （IQR: 1:16-1:128）。在多因素分析中，血清VDRL滴度≥1:32和存在神经系统症状与神经梅毒相关，而HIV病毒载量≤400拷贝/mm3是保护因素。除了存在神经系统症状外，HIV病毒载量>；本研究显示400拷贝/mm3和VDRL滴度≥1:32是神经梅毒的危险因素，在这些病例中应考虑诊断性腰椎穿刺。

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引用次数: 0

Gestational and congenital syphilis in the state of Rio de Janeiro, Brazil, 2021‒2023 巴西里约热内卢州妊娠期和先天性梅毒，2021-2023年

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-03-28 DOI: 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.

妊娠期梅毒（GS）和先天性梅毒（CS）是巴西重要的公共卫生问题。本研究旨在评估巴西2022年梅毒检出率和发病率最高的州巴西巴西里约热内卢州（RJS）的梅毒流行情况、梅毒发病率和梅毒垂直传播率（VT），以及梅毒管理指标。在2021-2023年期间，在RJS的公立和私立医院进行了一项以医院为基础的横断面研究，采访了1,923名妇女，分析了产前护理卡和医院记录。根据分娩或流产护理住院的资金来源，以各自的95%置信区间（95% CI）估计GS管理指标、GS患病率、CS发生率和VT率。93.7%的妇女报告了PNC， 82.7%的妇女进行了第一次梅毒检测，52.6%的妇女进行了第二次梅毒检测。GS患病率估计为14.5% (95% CI 9.2% - 22.2%)，在接受公共资助的妇女中患病率更高(18.2%公共资助；3.6%私人)。近三分之一的GS妇女仅在住院分娩或流产护理期间被诊断出来，13.4%的妇女在PNC期间得到适当治疗。CS的发病率估计为每1,000活产53.1例(每1,000名公众68.4例；9.7 / 1,000 LB（私人），VT率为33.5%，根据融资来源没有差异。GS的检出率和CS的发病率是巴西法定疾病信息系统报告的两倍。确定了几个错失的控制CS的机会。公共资助妇女的GS患病率和CS发病率较高，应成为控制战略的优先目标。

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引用次数: 0

Unmasking Prototheca wickerhamii: A rare case of cutaneous infection and its implications for clinical practice 揭露维克哈米氏原鞘：一个罕见的皮肤感染病例及其临床意义

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-03-27 DOI: 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.

原生藻是一种广泛存在于自然界的机会致病性藻类，已成为潜在的公共卫生问题。大多数病例发生在免疫功能低下的个体中，免疫功能正常的患者感染相对罕见。由于其非特异性临床表现和临床医生的认识有限，原鞘感染经常被误诊，导致治疗延误。物种鉴定和抗真菌药敏试验的最新进展为诊断和治疗提供了重要的工具。在这里，我们报告一例复发性面部感染在一个76岁的免疫能力的人。皮肤活检显示感染性肉芽肿，真菌培养发现酵母样菌落。荧光染色和扫描电镜显示大量孢子，宏基因组测序证实感染为威氏原芽孢杆菌。患者长期服用伊曲康唑和甘草酸二钾胶囊治疗成功。本病例强调了早期和准确诊断在原鞘皮肤感染管理中的重要性，并回顾了所使用的治疗策略。

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引用次数: 0