Brazilian Journal of Infectious Diseases最新文献_第7页

Prevalence and investigation of Cytomegalovirus (HCMV) in blood donors from the main blood establishment in Rio de Janeiro/Brazil 巴西里约热内卢主要血液机构献血者巨细胞病毒（HCMV）流行情况及调查

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-02-07 DOI: 10.1016/j.bjid.2025.104508

Agildo da Silva Oliveira , Jéssica Gonçalves Pereira , Gabrielle Tantos Nunes , Ivanildo Pedro de Sousa Junior , Dmitry José de Santana Sarmento , Josiane Iole França Lopes , Luiz Amorim Filho , Vanessa Salete de Paula

Background

Human Cytomegalovirus (HCMV) remains a significant cause of morbidity and mortality among pregnant women and immunocompromised patients. HCMV transmission can occur through blood transfusions and typically results in asymptomatic infections in newborns and young individuals or causes symptoms like infectious mononucleosis when symptomatic infections arise. HCMV infection poses a notable risk to transfusion recipients, particularly in vulnerable groups such as premature newborns and immunosuppressed patients. The risk persists even after prophylaxis ends, especially in patients who undergo organ transplantation and receive blood or blood products from a seropositive donor while being seronegative themselves (D+/R-).

Materials and methods

Here, we investigated the serological and molecular prevalence of HCMV among 980 blood donors from the main blood bank in Rio de Janeiro, Brazil, using chemiluminescence and real-time PCR (TaqMan). The data underwent univariate, bivariate, and multivariate statistical analyses using the SPSS program, version 20.0.

Results

The average age of donors was 38.53 years, with a majority being male (53.9 %). The prevalence of cytomegalovirus was 88.5 %, and HCMV DNA was detected in 1.2 % of the samples.

Discussion

Given that there are approximately 100,000 blood donations per year, this prevalence rate is considerably high compared to that in developed countries. These findings underscore the critical need for ongoing surveillance and molecular testing to ensure the safety of blood supplies.

人类巨细胞病毒（HCMV）仍然是孕妇和免疫功能低下患者发病和死亡的重要原因。HCMV可通过输血传播，通常导致新生儿和年轻人无症状感染，或在出现症状性感染时引起传染性单核细胞增多症等症状。HCMV感染对输血受者构成显著风险，特别是在早产儿和免疫抑制患者等弱势群体中。即使在预防结束后，风险仍然存在，特别是在接受器官移植并接受血清学阳性供者血液或血液制品而自身血清学阴性（D+/R-）的患者中。材料与方法采用化学发光和实时荧光定量PCR （TaqMan）技术，对巴西巴西里约热内卢市主要血库980名献血者进行了HCMV血清学和分子流行病学调查。使用SPSS 20.0版本对数据进行单变量、双变量和多变量统计分析。结果献血者平均年龄38.53岁，以男性居多（53.9%）。巨细胞病毒检出率为88.5%，HCMV DNA检出率为1.2%。鉴于每年大约有10万次献血，与发达国家相比，这一流行率相当高。这些发现强调了持续监测和分子检测以确保血液供应安全的迫切需要。

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引用次数: 0

A post-pandemic snapshot of the magnitude of COVID-19 in Brazil: A countrywide study 巴西COVID-19疫情大流行后的概况：一项全国性研究。

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.bjid.2024.104496

Eduardo Ribes Kohn , Maristela Bohlke , Antônia Almeida , Leandro Janelli , Luciana Monteiro Vasconcelos Sardinha , Fernando C. Wehrmeister , Pedro Curi Hallal

Objective

To outline the features of COVID-19 in Brazil through a countrywide telephone survey.

Methods

Data from the Telephone Survey of Risk Factors for Chronic Noncommunicable Diseases During the Pandemic (Covitel), a telephone survey of individuals aged 18 years or older from all macro-regions of Brazil, were used. The questionnaire included sociodemographic characteristics and outcomes related to COVID-19 infection, severity, vaccination, and use of masks.

Results

Data revealed that 34.7 % (95 %CI 32.4 – 37.1) of the population had been diagnosed with COVID-19, and 10.1 % (95 %CI 7.9 – 12.7) of those required hospital admission. The prevalence of COVID-19 diagnosis increased with education level: <8 years (26.6 % [95 %CI 23.1 – 30.7]), 9–11 years (33.4 % [95 %CI 29.4 – 37.7]), and >11 years (53.2 % [95 % CI 49.7 – 56.8]). Nevertheless, the hospitalization rate of Brazilians with more than eleven years of education was lower (5.8 % [95 %CI 4.3 – 7.6]). In 2023, 92.9 % (95 %CI 90.9 – 94.4) of the Brazilian population was fully vaccinated against COVID-19, but only 37.2 % (95 %CI 33.5 – 40.9) have received the updated vaccinal scheme (two doses and two boosters). During the pandemic outbreak, 81.9 % (95 %CI 79.4 – 84.2) reported always using face masks. However, only 16.1 % (95 %CI 13.5 – 19.0) maintained this practice in 2023.

Conclusion

There were inequalities in COVID-19 testing in Brazil. Testing and vaccination policies implemented in the COVID-19 pandemic must be reevaluated by the Brazilian government.

目的：通过全国电话调查，了解巴西新冠肺炎疫情特点。方法：使用来自大流行期间慢性非传染性疾病危险因素电话调查（Covitel）的数据，这是一项对巴西所有宏观区域18岁及以上个体的电话调查。调查问卷包括与COVID-19感染、严重程度、疫苗接种和口罩使用相关的社会人口学特征和结果。结果：数据显示34.7% （95% CI 32.4 - 37.1）的人群被诊断为COVID-19, 10.1% （95% CI 7.9 - 12.7）的人群需要住院治疗。随着受教育程度的增加，COVID-19诊断的患病率增加：11岁（53.2% [95% CI 49.7 - 56.8]）。然而，受过11年以上教育的巴西人的住院率较低（5.8% [95% CI 4.3 - 7.6]）。2023年，92.9% （95% CI 90.9 - 94.4）的巴西人口接种了COVID-19疫苗，但只有37.2% （95% CI 33.5 - 40.9）的人接种了更新的疫苗计划（两剂和两剂加强剂）。在大流行爆发期间，81.9% （95% CI 79.4 - 84.2）报告始终使用口罩。然而，只有16.1% （95% CI 13.5 - 19.0）在2023年坚持这种做法。结论：巴西COVID-19检测存在不平等现象。巴西政府必须重新评估2019冠状病毒病大流行期间实施的检测和疫苗接种政策。

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引用次数: 0

The need for novel influenza vaccines in low- and middle-income countries: A narrative review 低收入和中等收入国家对新型流感疫苗的需求：述评。

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.bjid.2024.104465

Julia R. Spinardi , Karan B. Thakkar , Verna L. Welch , Oladayo Jagun , Moe H. Kyaw

Influenza viruses cause 3–5 million severe cases and 300,000–600,000 deaths worldwide. Most of the disease burden is in Low- and Middle-Income Countries (LMICs) owing to factors such as high population density, infrastructure challenges, poor quality healthcare, lack of consistent recommendations, less prioritization of all high-risk groups, and prevalent use of trivalent influenza vaccines. Although influenza vaccines are effective in reducing the annual influenza disease burden, existing vaccines have several limitations. In this narrative review, we address the unmet needs of existing influenza vaccines in LMICs in Africa, Asia Pacific, Latin America and the Middle East and discuss the characteristics of novel vaccines in clinical development. We also describe features of a successful vaccination program that LMICs could emulate to improve their current vaccination coverage and reduce the public health burden of influenza.

流感病毒在全世界造成300万至500万严重病例和30万至60万人死亡。由于人口密度高、基础设施面临挑战、卫生保健质量差、缺乏一致的建议、对所有高危群体的重视程度较低以及普遍使用三价流感疫苗等因素，大多数疾病负担发生在低收入和中等收入国家。虽然流感疫苗在减少每年流感疾病负担方面是有效的，但现有疫苗有一些局限性。在这篇叙述性综述中，我们讨论了非洲、亚太、拉丁美洲和中东的中低收入国家对现有流感疫苗的未满足需求，并讨论了临床开发中新型疫苗的特点。我们还描述了一个成功的疫苗接种计划的特点，低收入和中等收入国家可以效仿，以提高其目前的疫苗接种覆盖率，减少流感的公共卫生负担。

引用次数: 0

Evidence-based clinical standard for the diagnosis and treatment of candidemia in critically ill patients in the intensive care unit 重症监护室危重患者念珠菌病诊疗循证临床标准。

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.bjid.2024.104495

Jorge Alberto Cortés , Martha Carolina Valderrama-Rios , Paula M. Peçanha-Pietrobom , Moacyr Silva Júnior , Cándida Diaz-Brochero , Rafael Ricardo Robles-Torres , Carmelo José Espinosa-Almanza , Laura Cristina Nocua-Báez , Marcio Nucci , Carlos Arturo Álvarez-Moreno , Flavio Queiroz-Telles , Ricardo Rabagliati , Rita Rojas-Fermín , Jorge L. Finquelievich , Fernando Riera , Patricia Cornejo-Juárez , Dora E. Corzo-León , Luis E. Cuéllar , Jeannete Zurita , Augusto Raúl Hernández , Arnaldo Lopes Colombo

Candidemia is the predominant form of invasive candidiasis and the most frequently occurring serious fungal infection in critically ill patients in Intensive Care Units (ICU). Studies carried out in Latin America reveal a higher incidence of candidemia and higher mortality rates when compared to North America or Europe. This highlights the need to develop guidelines for correctly diagnosing and treating candidemia in critically ill patients in the ICU. These guidelines are part of the efforts to implement antifungal optimization programs in the region to obtain better clinical outcomes and promote rational antifungal use. This evidence-based clinical standard, established through expert consensus for the Latin American context, contains recommendations and algorithms for diagnosing and treating candidemia in critically ill ICU patients.

念珠菌是侵袭性念珠菌病的主要形式，也是重症监护病房（ICU）危重患者中最常见的严重真菌感染。在拉丁美洲进行的研究表明，与北美或欧洲相比，该地区念珠菌的发病率和死亡率更高。这突出表明需要制定正确诊断和治疗ICU危重患者念珠菌的指南。这些指南是在该地区实施抗真菌优化方案的努力的一部分，以获得更好的临床结果并促进抗真菌药物的合理使用。这一基于证据的临床标准是根据拉丁美洲的专家共识制定的，包含诊断和治疗重症ICU患者念珠菌病的建议和算法。

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引用次数: 0

Activity of ceftolozane/tazobactam and comparators against gram-negative bacilli: Results from the Study for Monitoring Antimicrobial Resistance Trends (SMART – Brazil), 2018‒2021 头孢唑烷/他唑巴坦及其比较物对革兰氏阴性杆菌的活性：来自抗生素耐药性趋势监测研究的结果（SMART - Brazil）， 2018-2021。

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.bjid.2024.104497

Amanda Azevedo Bittencourt , Vinicius Lima Faustino , Paula de Mendonça Batista , Lays Paulino Leonel , Marina Della Negra de Paula , Thales José Polis

Increased spread of antimicrobial resistance by Gram-Negative Bacilli (GNB) poses a global challenge, with exacerbated burden post-pandemic. The aim of this study was to investigate the in vitro activity of ceftolozane/tazobactam and its comparators against the frequently identified GNB isolated from patients admitted to Brazilian medical sites between the year 2018‒2019 and 2020‒2021. The impact of pandemic on antimicrobial resistance and presence of β-lactamase genes were also evaluated. Antimicrobial susceptibility testing and molecular characterization of ß-lactamase encoding genes using Polymerase Chain Reaction (PCR) and DNA sequencing were carried out from GNB isolated mostly from intra-abdominal, respiratory, and urinary tract infections and interpreted following BrCAST/EUCAST guidelines. A total of 3994 GNB isolates were evaluated which mostly included E. coli, K. pneumoniae and P. aeruginosa. Ceftolozane/tazobactam remained highly active against E. coli isolates during both 2018‒2019 (96.0 %) and 2020‒2021 (98.5 %). Among K. pneumoniae, ceftolozane/tazobactam (47.6 % and 43.0 % susceptible during 2018‒2019 and 2020‒2021, respectively) showed poor activity due to bla_KPC-2. Colistin and ceftolozane/tazobactam were the most active β-lactam agents tested against P. aeruginosa in 2018‒2019 (99.3 % and 88.8 %) and 2020‒2021 (100 % and 92.8 %), including ceftazidime and meropenem resistant isolates. β-lactamase encoding gene characterization was carried out and both carbapenemases and Extended-Spectrum β-Lactamase (ESBL) producers were found in E. coli, K. pneumoniae and P. aeruginosa isolates. Ceftolozane/tazobactam documented remarkable in vitro activity against E. coli and P. aeruginosa isolates in Brazil, both pre- and post-pandemic periods and could constitute an effective therapeutic option for the treatment of urinary tract infections, intra-abdominal infections, and respiratory tract infections.

革兰氏阴性杆菌（GNB）抗菌素耐药性传播加剧构成全球挑战，大流行后负担加重。本研究的目的是研究头孢唑烷/他唑巴坦及其比较物对2018-2019年和2020-2021年期间巴西医疗机构入院患者中分离的常见GNB的体外活性。还评估了大流行对抗菌素耐药性和β-内酰胺酶基因存在的影响。采用聚合酶链反应（PCR）和DNA测序对主要来自腹腔、呼吸道和尿路感染的GNB进行了抗菌药敏试验和ß-内酰胺酶编码基因的分子鉴定，并按照BrCAST/EUCAST指南进行了解释。共鉴定出3994株GNB，主要包括大肠杆菌、肺炎克雷伯菌和铜绿假单胞菌。Ceftolozane/tazobactam在2018-2019年（96.0%）和2020-2021年（98.5%）对大肠杆菌分离株均保持高活性。在肺炎克雷伯菌中，头孢唑烷/他唑巴坦（2018-2019年和2020-2021年易感率分别为47.6%和43.0%）由于blaKPC-2而表现出较差的活性。粘菌素和头孢氧唑烷/他唑巴坦是2018-2019年和2020-2021年对铜绿假单胞菌（P. aeruginosa）最具活性的β-内酰胺类药物（分别为99.3%和88.8%），包括头孢他啶和美罗培南耐药菌株（分别为100%和92.8%）。对β-内酰胺酶编码基因进行了鉴定，发现大肠杆菌、肺炎克雷伯菌和铜绿假单胞菌中均存在碳青霉烯酶和广谱β-内酰胺酶（ESBL）产生物。头孢唑烷/他唑巴坦在巴西对大肠杆菌和铜绿假单胞菌分离株在大流行前和大流行后都有显著的体外活性，可能成为治疗尿路感染、腹腔感染和呼吸道感染的有效治疗选择。

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引用次数: 0

Sporotrichosis in the earlobe caused by placing an earing 耳垂上因佩戴耳环而出现孢子状赘生物。

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.bjid.2024.104464

Evelyn Zacarias , Talita Alves , Claudilson Bastos , Paulo Athanazio , Sergio Arruda

A 22-year-old woman presented with an ulcer on her right earlobe 2 months ago, with inflammation and enlarged ipsilateral lymph nodes in her neck. She was treated with antibiotics without success and then was referred to an infectious disease specialist. She has a cat at home with sporotrichosis, but without direct contact with the lesion, she did not remember any scratching by the cat. She also mentioned wearing a semi-jewel earring. This is a rare and unusual case of sporotrichosis in the earlobe, probably caused by wearing an earring contaminated by the cat's fungus that was present in the home environment. The delay in diagnosis and treatment led to the worsening of the injury and loss of the earlobe.

22岁女性，2个月前右耳垂溃疡，伴炎症及颈部同侧淋巴结肿大。她接受了抗生素治疗，但没有成功，然后被转介给传染病专家。她家中有一只患有孢子虫病的猫，但没有直接接触病变，她不记得猫有任何抓伤。她还提到戴了一个半宝石耳环。这是一种罕见且不寻常的耳垂孢子菌病，可能是由于佩戴了被家庭环境中存在的猫真菌污染的耳环而引起的。诊断和治疗的延误导致耳垂损伤的恶化和丧失。

引用次数: 0

Investigation of natural infection of BALB C mice by Bartonella henselae 亨塞拉巴尔通体自然感染BALB - C小鼠的研究

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2024-11-29 DOI: 10.1016/j.bjid.2024.104483

Luciene Silva dos Santos , Sayros Akyro Soares Martins , Francine Ramos Scheffer , Alexandre Seiji Maekawa , Rafaela de Paula Silva , Gabriel Rabelo de Araújo , Paulo Eduardo Neves Ferreira Velho , Marina Rovani Drummond

Specific Pathogen-Free (SPF) animals are bred and maintained to exclude pathogens associated with significant morbidity or mortality, which may pose a risk to research replicability. The BALB/c strain is distributed globally and is among the most commonly used inbred strains in immunology and infectious disease research. Despite being a widely distributed bacterium that causes chronic infection, Bartonella henselae infection has not been investigated in any protocol that characterizes SPF animals. The objective of this study was to investigate the potential natural infection of laboratory animals of the BALB/c lineage by B. henselae. To achieve this, ten immunocompetent BALB/c mice were obtained directly from the bioterium and euthanized for collection of samples, including blood, skin, spleen, liver, heart, eye, kidney, intestine, esophagus, and brain. DNA was extracted using a commercial kit and tested via nested PCR for the ftsZ gene, as well as conventional PCR and qualitative real-time PCR using Sybr® Green for the citrate synthase gene (gltA), all specific reactions for B. henselae. All animals showed detection of B. henselae DNA in at least two different reactions in different tissues. The sequenced amplicons showed 100 % similarity to B. henselae. The use of mice infected by B. henselae in experiments is undesirable, as the bacteria can affect several aspects of the animal's physiology and consequently influence the results of the project, especially when subjected to immunosuppression. More studies are needed to understand and confirm the natural infection in experimental animals by Bartonella spp.. To date, no additional published reports of contamination of experimental animals by these bacteria have been identified.

特定无病原体（SPF）动物的饲养和维护是为了排除与显著发病率或死亡率相关的病原体，这可能对研究的可重复性构成风险。BALB/c毒株分布全球，是免疫学和传染病研究中最常用的近交系之一。尽管亨塞巴尔通体是一种广泛分布的引起慢性感染的细菌，但在SPF动物的任何方案中尚未对其感染进行调查。本研究的目的是探讨B. henselae对BALB/c系实验动物的潜在自然感染。为此，直接从菌群中获得10只具有免疫能力的BALB/c小鼠，并对其实施安乐死，收集血液、皮肤、脾脏、肝脏、心脏、眼睛、肾脏、肠道、食道和大脑等样本。使用商业试剂盒提取DNA，并通过巢式PCR检测ftsZ基因，以及使用Sybr®Green进行常规PCR和定性实时PCR检测柠檬酸合成酶基因（gltA），所有特异性反应均针对B. henselae。所有动物在不同组织中至少两种不同的反应中检测到亨selae的DNA。测序扩增结果显示，该扩增产物与亨selae的相似性为100%。在实验中使用受henselae感染的小鼠是不可取的，因为细菌可以影响动物生理的几个方面，从而影响项目的结果，特别是当受到免疫抑制时。需要更多的研究来了解和证实巴尔通体在实验动物中的自然感染。到目前为止，还没有发现实验动物受到这些细菌污染的其他已发表报告。

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引用次数: 0

Presence of dengue virus RNA in urine and oral fluid of laboratory-confirmed dengue patients: Implications for wastewater surveillance 实验室确诊登革热患者尿液和口腔液中存在登革热病毒RNA：对废水监测的影响

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2024-11-29 DOI: 10.1016/j.bjid.2024.104484

Christine Stauber , Leile Camila Jacob-Nascimento , Caroline Grosch , Moisés da Silva Sousa , Moyra M. Portilho , Rosângela O. Anjos , Margo A. Brinton , Uriel Kitron , Mitermayer G. Reis , Guilherme S. Ribeiro

Introduction

Dengue cases in the Americas in 2024 have reached record highs, especially in Brazil. However, surveillance remains suboptimal and new methods are needed to monitor Dengue Virus (DENV) spread. To assess whether wastewater-based epidemiology would be a useful tool, we investigated the presence of DENV RNA in dengue patients’ urine and oral fluid from an endemic area to inform how shedding in these fluids occurs and provide insight for wastewater surveillance.

Methods

We examined how often DENV RNA is detected in urine and oral fluid from dengue patients confirmed by serum RT-qPCR, NS1 ELISA or IgM seroconversion in Salvador, Brazil.

Results

Of 88 confirmed cases, 9.1 % were positive for DENV RNA in urine (7/88) or oral fluid (1/88). Of 53 serum RT-qPCR-positive patients, 6 (11.3 %) showed detectable DENV RNA in acute- or convalescent-phase urine. Patients with RT-qPCR-positive urine had a lower frequency of DENV IgG in acute-phase serum (a proxy for secondary infection) (57 % vs. 74 %) and a lower median serum RT-qPCR cycle threshold than those with negative urine (21.8 vs. 23.9).

Conclusion

The low presence of DENV RNA in urine suggests that additional research is needed to evaluate whether using wastewater-based epidemiology to monitor DENV transmission is possible.

2024年美洲的登革热病例达到历史新高，特别是在巴西。然而，监测仍然不够理想，需要新的方法来监测登革热病毒（DENV）的传播。为了评估基于废水的流行病学是否会成为一种有用的工具，我们调查了登革热流行地区登革热患者尿液和口腔液中DENV RNA的存在，以了解这些液体中的脱落是如何发生的，并为废水监测提供见解。方法对巴西萨尔瓦多地区经血清RT-qPCR、NS1 ELISA或IgM血清转化确诊的登革热患者尿液和口腔液中DENV RNA的检测频率进行检测。结果在88例确诊病例中，尿（7/88）和口服液（1/88）DENV RNA阳性率为9.1%。在53例血清rt - qpcr阳性患者中，6例（11.3%）在急性期或恢复期尿液中检测到DENV RNA。尿RT-qPCR阳性的患者在急性期血清中DENV IgG（继发感染的代理）的频率较低（57%对74%），血清中位RT-qPCR周期阈值低于尿阴性的患者（21.8对23.9）。结论尿中DENV RNA的低含量表明，需要进一步研究以废水为基础的流行病学监测DENV传播是否可行。

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引用次数: 0

Dysregulation in the microbiota by HBV and HCV infection induces an altered cytokine profile in the pathobiome of infection 乙型肝炎病毒和丙型肝炎病毒感染引起的微生物群失调导致感染病理组中细胞因子谱的改变

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2024-11-28 DOI: 10.1016/j.bjid.2024.104468

Marcos Daniel Mendes Padilha , Francisco Tiago de Vasconcelos Melo , Rogério Valois Laurentino , Andrea Nazaré Monteiro Rangel da Silva , Rosimar Neris Martins Feitosa

Viral hepatitis is a public health problem, about 1 million people die due to complications of this viral disease, the etiological agents responsible for inducing cirrhosis and cellular hepatocarcinoma are HBV and HCV, both hepatotropic viruses that cause asymptomatic infection in most cases. The regulation of the microbiota performs many physiological functions, which can induce normal intestinal function and produce essential nutrients for the human body. Metabolites derived from gut microbiota or direct regulation of host immunity and metabolism have been reported to profoundly affect tumorigenesis in liver disease. If the microbiota is unbalanced, both exogenous and symbiotic microorganisms can affect a pathological process. It is well understood that the microbiota plays a role in viral diseases and infections, specifically the hepatic portal pathway has been linked to the gut-liver axis. In HBV and HCV infections, the altered bacterial representatives undergo a state of dysbiosis, with subsequent establishment of the pathobiome with overexpression of taxons such as Bacteroides, Clostridium, Lactobacillus, Enterobacter, and Enterococcus. This dysregulated microbiome induces a microenvironment conducive to the development of hepatic complications in patients with acute and chronic HBV and HCV infection, with subsequent dysregulation of cytokines IFN-α/β, TNF-α, IL-1β, TGF-β, IL-6 and IL-10, which alter the dysfunction and damage of the hepatic portal system. In view of the above, this review aimed to correlate the pathophysiological mechanisms in HBV and HCV infection, the dysregulation of the microbiome in patients infected with HBV and HCV, the most altered cytokines in the microbiome, and the most altered bacterial representatives in the pathobiome of infection.

病毒性肝炎是一个公共卫生问题，约有100万人死于这种病毒性疾病的并发症，导致肝硬化和细胞性肝癌的病因是HBV和HCV，这两种嗜肝病毒在大多数情况下引起无症状感染。微生物群的调节具有多种生理功能，可以诱导肠道功能正常，产生人体必需的营养物质。据报道，来自肠道微生物群的代谢物或直接调节宿主免疫和代谢对肝脏疾病的肿瘤发生有深远的影响。如果微生物群不平衡，外源和共生微生物都可以影响病理过程。众所周知，微生物群在病毒性疾病和感染中发挥作用，特别是肝门静脉通路与肠-肝轴有关。在HBV和HCV感染中，改变的细菌代表经历了一种生态失调状态，随后建立了病原体组，并过度表达类群，如拟杆菌、梭状芽胞杆菌、乳杆菌、肠杆菌和肠球菌。这种失调的微生物组诱导了一个有利于急性和慢性HBV和HCV感染患者肝脏并发症发展的微环境，随后细胞因子IFN-α/β、TNF-α、IL-1β、TGF-β、IL-6和IL-10的失调，从而改变肝门静脉系统的功能障碍和损害。鉴于此，本综述旨在探讨HBV和HCV感染的病理生理机制、HBV和HCV感染患者微生物组的失调、微生物组中改变最多的细胞因子以及感染病理组中改变最多的细菌代表。

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引用次数: 0

Hospitalization due to pneumococcal disease in the Unified Health System in Brazil: A retrospective analysis of administrative data 巴西统一卫生系统中因肺炎球菌疾病住院的情况：行政数据的回顾性分析

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2024-11-27 DOI: 10.1016/j.bjid.2024.104482

Daniela V. Pachito , Mauricio Longato , Guilherme Cordeiro , Paulo H.R.F. Almeida , Ricardo Macarini Ferreira , Ana Paula N. Burian

Introduction

Community-Acquired Pneumonia (CAP) caused by pneumococcus and Invasive Pneumococcal Disease (IPD) pose a substantial economic burden on health systems. The objective of the present study is to explore hospitalization costs of pneumococcal disease in the public health system in Brazil, the Unified Health System.

Methods

Retrospective analysis of administrative data on hospitalized cases of pneumococcal disease from January 2019 to July 2023. Hospitalization cases recorded with ICD-10 codes of CAP due to S. pneumoniae and IPD were retrieved from DATASUS, the inpatient information system of the Unified Health System in Brazil. Costs were converted to US dollars by Using Purchasing Power Parity (USD-PPP). Absolute number of hospitalizations, costs of hospitalizations and healthcare resource utilization were presented descriptively. The annual cost estimate was calculated. Differences in costs by type of clinical presentation and age group were assessed. Factors associated with higher costs were explored by multiple linear regression models.

Results

A total of 22,498 hospitalization episodes were analyzed. Total cost of hospitalizations was USD-PPP 13,958,959 (BRL 34,659,578) with an annual mean estimate of USD-PPP 3,045,591 (BRL 7,562,090). Cost per hospitalization episode was significantly higher for meningitis, followed by septicemia, CAP and arthritis, with median values ranging from USD-PPP 190.93 to 615.14 (BRL 476.20 to 1529.02). (Kruskal-Wallis χ² = 6473, df = 3, p-value < 0.0001). Costs were significantly higher among individuals aged 60-years and older. (Kruskal-Wallis test; χ² = 773.53; df = 2, p-value < 0.0001). There were differences in age at hospitalization, length of stay, and ICU utilization among types of clinical presentations.

Conclusions

Our findings reveal the economic burden associated with pneumococcal disease in the Unified Health System in Brazil. Hospitalization costs were higher for cases of meningitis and among individuals aged 60-years and above.

引言肺炎球菌引起的社区获得性肺炎 (CAP) 和侵袭性肺炎球菌疾病 (IPD) 给卫生系统造成了巨大的经济负担。本研究旨在探讨巴西公共卫生系统（统一卫生系统）中肺炎球菌疾病的住院费用。方法回顾性分析 2019 年 1 月至 2023 年 7 月肺炎球菌疾病住院病例的管理数据。从巴西统一卫生系统（Unified Health System）的住院病人信息系统 DATASUS 中检索记录了 ICD-10 代码为肺炎链球菌引起的 CAP 和 IPD 的住院病例。费用按购买力平价（USD-PPP）换算成美元。对住院绝对人数、住院费用和医疗资源利用情况进行了描述性说明。计算了年度成本估算。评估了不同临床表现类型和年龄组的成本差异。通过多元线性回归模型探讨了与较高费用相关的因素。住院总费用为13,958,959美元（34,659,578巴西雷亚尔），年平均费用估计为3,045,591美元（7,562,090巴西雷亚尔）。脑膜炎的每次住院费用明显较高，其次是败血症、CAP 和关节炎，中值范围为 190.93 至 615.14 美元（476.20 至 1529.02 巴西雷亚尔）。(Kruskal-Wallis χ2 = 6473，df = 3，p-value < 0.0001）。60 岁及以上人群的费用明显更高。(Kruskal-Wallis 检验；χ2 = 773.53；df = 2，P 值为 0.0001）。结论我们的研究结果揭示了巴西统一卫生系统中与肺炎球菌疾病相关的经济负担。脑膜炎病例和 60 岁及以上人群的住院费用较高。

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引用次数: 0