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}
Pub Date : 2025-02-21DOI: 10.1016/j.bjid.2025.104510
Julio Alejandro Cedeno , Tania Mara Varejão Strabelli , Bruno Adler Maccagnan Pinheiro Besen , Rafael de Freitas Souza , Denise Blini Sierra , Leticia Rodrigues Goulart de Souza , Samuel Terra Gallafrio , Cely Saad Abboud , Diego Feriani , Rinaldo Focaccia Siciliano
Introduction
We aimed to create and validate the 30-day prognostic score for mortality in patients with surgical wound infection (SWICS-30) after cardiothoracic surgery.
Methods
This retrospective study enrolled patients with surgical wound infection following cardiothoracic surgery admitted to a Cardiologic Reference Center Hospital between January 2006 and January 2023. Clinical data and commonly used blood tests were analyzed at the time of diagnosis. An independent scoring system was developed through logistic regression analysis and validated using Artificial intelligence.
Results
From 1713 patients evaluated (mean age of 60 years (18–89), 55 % female), 143 (8.4 %) experienced 30-day mortality. The SWICS-30 logistic regression score comprised the following variables: age over 65 years, undergoing valve heart surgery, combined coronary and valve heart surgery, heart transplantation, time from surgery to infection diagnosis exceeding 21 days, leukocyte count over 13,000/mm3, lymphocyte count below 1000/mm3, platelet count below 150,000/mm3, and creatinine level exceeding 1.5 mg/dL. These patients were stratified into low (2.7 %), moderate (14.2 %), and high (47.1 %) in-hospital mortality risk categories. Artificial intelligence confirmed accuracy at 90 %.
{"title":"Early prediction of 30-day mortality in patients with surgical wound infections following cardiothoracic surgery: Development and validation of the SWICS-30 score utilizing conventional logistic regression and artificial neural network","authors":"Julio Alejandro Cedeno , Tania Mara Varejão Strabelli , Bruno Adler Maccagnan Pinheiro Besen , Rafael de Freitas Souza , Denise Blini Sierra , Leticia Rodrigues Goulart de Souza , Samuel Terra Gallafrio , Cely Saad Abboud , Diego Feriani , Rinaldo Focaccia Siciliano","doi":"10.1016/j.bjid.2025.104510","DOIUrl":"10.1016/j.bjid.2025.104510","url":null,"abstract":"<div><h3>Introduction</h3><div>We aimed to create and validate the 30-day prognostic score for mortality in patients with surgical wound infection (SWICS-30) after cardiothoracic surgery.</div></div><div><h3>Methods</h3><div>This retrospective study enrolled patients with surgical wound infection following cardiothoracic surgery admitted to a Cardiologic Reference Center Hospital between January 2006 and January 2023. Clinical data and commonly used blood tests were analyzed at the time of diagnosis. An independent scoring system was developed through logistic regression analysis and validated using Artificial intelligence.</div></div><div><h3>Results</h3><div>From 1713 patients evaluated (mean age of 60 years (18–89), 55 % female), 143 (8.4 %) experienced 30-day mortality. The SWICS-30 logistic regression score comprised the following variables: age over 65 years, undergoing valve heart surgery, combined coronary and valve heart surgery, heart transplantation, time from surgery to infection diagnosis exceeding 21 days, leukocyte count over 13,000/mm3, lymphocyte count below 1000/mm3, platelet count below 150,000/mm3, and creatinine level exceeding 1.5 mg/dL. These patients were stratified into low (2.7 %), moderate (14.2 %), and high (47.1 %) in-hospital mortality risk categories. Artificial intelligence confirmed accuracy at 90 %.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 2","pages":"Article 104510"},"PeriodicalIF":3.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454881","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 : 2025-02-19DOI: 10.1016/j.bjid.2025.104509
João Paulo Borges de Melo, Alex Eduardo da Silva, Leandro Resende Yamamoto, Taciana Fernandes Araújo Ferreira, Gustavo José Luvizutto, Fernando Freitas Neves, Kelly Cristina Santos, Roger Lopes Batista, Isabel Cunha Santos, Francielle Schiavoni, Mario León Silva-Vergara
Introduction
Post-COVID Syndrome (PCS), occurs several weeks after Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2 infection), has a frequency of 10 %‒35 % of cases, presents a wide range of symptoms that can persist for months or years and markedly reduces the quality of life of patients.
Objective
To describe clinical, epidemiological and evolutionary aspects of a cohort of patients diagnosed with PCS followed on an outpatient basis.
Methodology
Individuals of both sexes, > 18-years old who presented symptoms suggestive of PCS and had previously confirmed SARS-CoV-2 infection were included. Clinical evaluation was carried out monthly by a multidisciplinary team, and if necessary laboratorial exams were performed.
Results
From June 2021 to June 2022, 92 cases of PCS were diagnosed, of which 60 (65.2 %) were female and the average age was 49.1 years. In 61 (66.3 %) of the cases, SARS-CoV-2 infection occurred between January and November 2021. In 55 (59.7 %) of the cases the symptoms were mild, while 31 (36.0 %) were moderate or severe cases. Most cases of PCS occurred in individuals with the mild form of COVID-19. The predominant symptoms were chronic fatigue in 59 (68.6 %) cases, brain fog in 68 (73.4 %), myalgias and arthralgias in 44 (47.8 %), cramps and paresthesia's in 40 (46.5 %). The main comorbidities observed were high blood pressure, obesity and diabetes mellitus. The persistence of symptoms was greater in those cases who presented severe forms of COVID-19. Most patients experienced gradual and progressive improvement over the months.
Discussion
The profile of patients with PCS in this cohort is similar to other reports. A great number of symptoms is remarkable with variable presentation and evolution and their frequency exceeds that previously described in a large meta-analysis. Inflammatory phenomena mediated by the virus, autoimmunity and direct organic damage have been implicated in the genesis of this syndrome.
{"title":"Demographic, epidemiological and clinical profile of patients with post-COVID syndrome followed at a teaching hospital in Brazil","authors":"João Paulo Borges de Melo, Alex Eduardo da Silva, Leandro Resende Yamamoto, Taciana Fernandes Araújo Ferreira, Gustavo José Luvizutto, Fernando Freitas Neves, Kelly Cristina Santos, Roger Lopes Batista, Isabel Cunha Santos, Francielle Schiavoni, Mario León Silva-Vergara","doi":"10.1016/j.bjid.2025.104509","DOIUrl":"10.1016/j.bjid.2025.104509","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-COVID Syndrome (PCS), occurs several weeks after Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2 infection), has a frequency of 10 %‒35 % of cases, presents a wide range of symptoms that can persist for months or years and markedly reduces the quality of life of patients.</div></div><div><h3>Objective</h3><div>To describe clinical, epidemiological and evolutionary aspects of a cohort of patients diagnosed with PCS followed on an outpatient basis.</div></div><div><h3>Methodology</h3><div>Individuals of both sexes, > 18-years old who presented symptoms suggestive of PCS and had previously confirmed SARS-CoV-2 infection were included. Clinical evaluation was carried out monthly by a multidisciplinary team, and if necessary laboratorial exams were performed.</div></div><div><h3>Results</h3><div>From June 2021 to June 2022, 92 cases of PCS were diagnosed, of which 60 (65.2 %) were female and the average age was 49.1 years. In 61 (66.3 %) of the cases, SARS-CoV-2 infection occurred between January and November 2021. In 55 (59.7 %) of the cases the symptoms were mild, while 31 (36.0 %) were moderate or severe cases. Most cases of PCS occurred in individuals with the mild form of COVID-19. The predominant symptoms were chronic fatigue in 59 (68.6 %) cases, brain fog in 68 (73.4 %), myalgias and arthralgias in 44 (47.8 %), cramps and paresthesia's in 40 (46.5 %). The main comorbidities observed were high blood pressure, obesity and diabetes mellitus. The persistence of symptoms was greater in those cases who presented severe forms of COVID-19. Most patients experienced gradual and progressive improvement over the months.</div></div><div><h3>Discussion</h3><div>The profile of patients with PCS in this cohort is similar to other reports. A great number of symptoms is remarkable with variable presentation and evolution and their frequency exceeds that previously described in a large meta-analysis. Inflammatory phenomena mediated by the virus, autoimmunity and direct organic damage have been implicated in the genesis of this syndrome.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 2","pages":"Article 104509"},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445309","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}
The incidence of Late-Onset Sepsis (LOS) increases as gestational age decreases in newborns. The clinical signs of neonatal sepsis are not specific for diagnosis in preterm infants. The gold standard for its diagnosis is the blood culture test, which requires more than 24 h to obtain results, with positive results obtained in 10–3 % of cases analysed. As the molecular markers on the lymphocyte surface CD64 and CD69 are involved in early innate immune activation, they may be helpful for faster diagnosis.
Aim
Measure the expression of CD64 and CD69 on lymphocytes in clinical and confirmed sepsis patients and compared to that in infants without sepsis.
Methodology
We used peripheral blood samples from three groups of preterm babies with suspected sepsis (n = 31), confirmed sepsis (n = 10) and without sepsis (n = 47). Using flow cytometry, we measure the expression of CD64 on neutrophils and CD69 on NK cells.
Results
Expression of CD64 on neutrophils and CD69 on NK cells did not increase in the clinical or confirmed sepsis groups compared to the without sepsis group.
Conclusions
Leukocytes from infants born prematurely may have tightly regulated mechanisms that control their activation phenotype, rendering them unsuitable for diagnosing sepsis.
{"title":"Expression of CD64 and CD69 as biomarkers for late-onset sepsis diagnosis in infants born prematurely","authors":"Alicia Ramírez-Ramírez, Ismael Mancilla-Herrera, Ricardo Figueroa-Damián, Diana Soriano-Becerril, Graciela Villeda-Gabriel","doi":"10.1016/j.bjid.2025.104511","DOIUrl":"10.1016/j.bjid.2025.104511","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of Late-Onset Sepsis (LOS) increases as gestational age decreases in newborns. The clinical signs of neonatal sepsis are not specific for diagnosis in preterm infants. The gold standard for its diagnosis is the blood culture test, which requires more than 24 h to obtain results, with positive results obtained in 10–3 % of cases analysed. As the molecular markers on the lymphocyte surface CD64 and CD69 are involved in early innate immune activation, they may be helpful for faster diagnosis.</div></div><div><h3>Aim</h3><div>Measure the expression of CD64 and CD69 on lymphocytes in clinical and confirmed sepsis patients and compared to that in infants without sepsis.</div></div><div><h3>Methodology</h3><div>We used peripheral blood samples from three groups of preterm babies with suspected sepsis (<em>n</em> = 31), confirmed sepsis (<em>n</em> = 10) and without sepsis (<em>n</em> = 47). Using flow cytometry, we measure the expression of CD64 on neutrophils and CD69 on NK cells.</div></div><div><h3>Results</h3><div>Expression of CD64 on neutrophils and CD69 on NK cells did not increase in the clinical or confirmed sepsis groups compared to the without sepsis group.</div></div><div><h3>Conclusions</h3><div>Leukocytes from infants born prematurely may have tightly regulated mechanisms that control their activation phenotype, rendering them unsuitable for diagnosing sepsis.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 2","pages":"Article 104511"},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436701","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 : 2025-02-19DOI: 10.1016/j.bjid.2025.104514
Noemia Teixeira de Siqueira Filha , Fanny Cortes , Meline Kron , Maira Galdino da Rocha Pitta , Fernando Zanghelini , Bruna de Veras , Tatiane Almeida Menezes , Ana Medina , Lessandra Michelin , Thatiana Pinto
This study describes and estimates the social and economic impact of Invasive Meningococcal Disease (IMD) sequelae globally and in Brazil. An integrative review was conducted to identify IMD sequelae costs estimates worldwide. The evidence identified supported the development of a Delphi survey to estimate medical Resource Use (RU) and caregiver productivity loss during the first Year (Y1) of IMD and the Subsequent Year (SY) in Brazil. Treatment costs of long-term IMD sequelae were estimated through microcosting approach using Brazilian cost reference tables and taking into account the Delphi survey estimates. The review included eight studies from high-income countries. Mean costs of IMD sequelae in high-income countries varied substantially by type of sequelae in Y1 (hearing loss $14,511; amputation $144,087), type of care over a lifetime horizon (outpatient $28,498; inpatient $67,038), and medical procedure over a lifetime horizon (shunt revision $22,794; prosthesis $508,735). The Delphi survey indicated that medical RU was significantly higher in Y1 versus SY. Resource use was highest for patients with multiple limb amputations. In addition, the highest number of outpatient visits (32) were required for patients with skin scars; speech therapy (72) for hearing loss; and the most psychologist sessions (116) for mental health disorders in Y1. Similarly, estimated treatment costs were highest for patients with multiple limb amputations ($4,139.70 in Y1 and $1,874.39 for SY), followed by single limb amputation ($2,803.24 in Y1 and $902.73 for SY) and skin scarring ($2,307.69 in Y1 and $816.19 for SY). All sequelae resulted in multiple workdays lost for caregivers, ranging from 33 (skin scarring) to 85 (multiple limbs amputation) during the first year of treatment. This study informs decision-makers on the healthcare, social and educational services, and social protection needs of patients with long-term sequelae in Brazil and globally.
{"title":"Treatment costs of long-term invasive meningococcal disease sequelae: A literature review and Delphi study in Brazil","authors":"Noemia Teixeira de Siqueira Filha , Fanny Cortes , Meline Kron , Maira Galdino da Rocha Pitta , Fernando Zanghelini , Bruna de Veras , Tatiane Almeida Menezes , Ana Medina , Lessandra Michelin , Thatiana Pinto","doi":"10.1016/j.bjid.2025.104514","DOIUrl":"10.1016/j.bjid.2025.104514","url":null,"abstract":"<div><div>This study describes and estimates the social and economic impact of Invasive Meningococcal Disease (IMD) sequelae globally and in Brazil. An integrative review was conducted to identify IMD sequelae costs estimates worldwide. The evidence identified supported the development of a Delphi survey to estimate medical Resource Use (RU) and caregiver productivity loss during the first Year (Y1) of IMD and the Subsequent Year (SY) in Brazil. Treatment costs of long-term IMD sequelae were estimated through microcosting approach using Brazilian cost reference tables and taking into account the Delphi survey estimates. The review included eight studies from high-income countries. Mean costs of IMD sequelae in high-income countries varied substantially by type of sequelae in Y1 (hearing loss $14,511; amputation $144,087), type of care over a lifetime horizon (outpatient $28,498; inpatient $67,038), and medical procedure over a lifetime horizon (shunt revision $22,794; prosthesis $508,735). The Delphi survey indicated that medical RU was significantly higher in Y1 versus SY. Resource use was highest for patients with multiple limb amputations. In addition, the highest number of outpatient visits (32) were required for patients with skin scars; speech therapy (72) for hearing loss; and the most psychologist sessions (116) for mental health disorders in Y1. Similarly, estimated treatment costs were highest for patients with multiple limb amputations ($4,139.70 in Y1 and $1,874.39 for SY), followed by single limb amputation ($2,803.24 in Y1 and $902.73 for SY) and skin scarring ($2,307.69 in Y1 and $816.19 for SY). All sequelae resulted in multiple workdays lost for caregivers, ranging from 33 (skin scarring) to 85 (multiple limbs amputation) during the first year of treatment. This study informs decision-makers on the healthcare, social and educational services, and social protection needs of patients with long-term sequelae in Brazil and globally.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 2","pages":"Article 104514"},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445310","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 : 2025-02-12DOI: 10.1016/j.bjid.2025.104513
Jorge Francisco da Cunha Pinto , Luiza Brito Gomes , Natalia Dias Melo , Fabiana Barbosa Assumpção de Souza , Debora Viana Freitas , Sara Gonzalez Viega , Erica Ramos dos Santos Nascimento , Lidia Theodoro Boullosa , Cynthia Chester Cardoso , Amilcar Tanuri
Background
Dolutegravir (DTG) is widely used as a first-line Antiretroviral Therapy (ART) due to its high efficacy and safety. However, concerns about DTG resistance persist. This study investigated the prevalence and factors associated with transmitted DTG resistance in treatment-naive HIV-1-infected individuals in Brazil.
Methods
The study followed 150 treatment-naive HIV-1 individuals from May 2019 to May 2022 at a reference center for HIV/AIDS in Rio de Janeiro, Brazil. Baseline characteristics, viral load, and CD4 + cell counts were assessed. Genotypic resistance testing was conducted on plasma samples at baseline, and viral load was monitored during follow-up visits.
Results
One hundred and thirty-one patients completed the study. The mean age was 37.73-years; 107 were male, and 24 were female. The median baseline of viral load was 4.33 log (21,193 copies/mm3), and CD4 + count was 342 cells/mm3, with the lowest count being 8 cells/mm3. The mean CD4 + count increase was 112 cells/mm3 (p < 0.01). One hundred and nine patients achieved an undetectable viral load three months after starting ART, with only eight patients not reaching undetectable levels by six months (42‒106 copies/mm3). The most common early adverse effect was nausea (12.9 %), and the most common later effect was increased creatinine levels (9.1 %), leading to the suspension or substitution of Tenofovir Disoproxil Fumarate (TDF). Genotyping was successfully performed on 85 patients: 66 were subtype B, 9 subtype C, 8 subtype F, and two CRF47_BF, with no resistance mutations and one accessory mutation (T97A).
Conclusion
This study did not demonstrate transmitted DTG resistance among treatment-naive HIV-1-infected individuals. The findings suggest that DTG remains a safe and effective first-line ART option. However, close monitoring of viral load is recommended for all patients on DTG-containing ART regimens. Additionally, genotypic resistance testing should be performed on individuals who experience virological failure or a significant decline in CD4 + cell counts, with close attention to ART adherence.
{"title":"Transmission of Dolutegravir resistance in treatment-naive individuals with HIV-1: A cohort study","authors":"Jorge Francisco da Cunha Pinto , Luiza Brito Gomes , Natalia Dias Melo , Fabiana Barbosa Assumpção de Souza , Debora Viana Freitas , Sara Gonzalez Viega , Erica Ramos dos Santos Nascimento , Lidia Theodoro Boullosa , Cynthia Chester Cardoso , Amilcar Tanuri","doi":"10.1016/j.bjid.2025.104513","DOIUrl":"10.1016/j.bjid.2025.104513","url":null,"abstract":"<div><h3>Background</h3><div>Dolutegravir (DTG) is widely used as a first-line Antiretroviral Therapy (ART) due to its high efficacy and safety. However, concerns about DTG resistance persist. This study investigated the prevalence and factors associated with transmitted DTG resistance in treatment-naive HIV-1-infected individuals in Brazil.</div></div><div><h3>Methods</h3><div>The study followed 150 treatment-naive HIV-1 individuals from May 2019 to May 2022 at a reference center for HIV/AIDS in Rio de Janeiro, Brazil. Baseline characteristics, viral load, and CD4 + cell counts were assessed. Genotypic resistance testing was conducted on plasma samples at baseline, and viral load was monitored during follow-up visits.</div></div><div><h3>Results</h3><div>One hundred and thirty-one patients completed the study. The mean age was 37.73-years; 107 were male, and 24 were female. The median baseline of viral load was 4.33 log (21,193 copies/mm<sup>3</sup>), and CD4 + count was 342 cells/mm<sup>3</sup>, with the lowest count being 8 cells/mm<sup>3</sup>. The mean CD4 + count increase was 112 cells/mm<sup>3</sup> (<em>p</em> < 0.01). One hundred and nine patients achieved an undetectable viral load three months after starting ART, with only eight patients not reaching undetectable levels by six months (42‒106 copies/mm<sup>3</sup>). The most common early adverse effect was nausea (12.9 %), and the most common later effect was increased creatinine levels (9.1 %), leading to the suspension or substitution of Tenofovir Disoproxil Fumarate (TDF). Genotyping was successfully performed on 85 patients: 66 were subtype B, 9 subtype C, 8 subtype F, and two CRF47_BF, with no resistance mutations and one accessory mutation (T97A).</div></div><div><h3>Conclusion</h3><div>This study did not demonstrate transmitted DTG resistance among treatment-naive HIV-1-infected individuals. The findings suggest that DTG remains a safe and effective first-line ART option. However, close monitoring of viral load is recommended for all patients on DTG-containing ART regimens. Additionally, genotypic resistance testing should be performed on individuals who experience virological failure or a significant decline in CD4 + cell counts, with close attention to ART adherence.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 2","pages":"Article 104513"},"PeriodicalIF":3.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387652","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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