Enfermedades infecciosas y microbiologia clinica (English ed.)最新文献_第2页

Tecovirimat hepatotoxicity in a man with Mpox infection 替可韦莫对m痘患者的肝毒性

Enfermedades infecciosas y microbiologia clinica (English ed.)

Pub Date : 2026-02-01 DOI: 10.1016/j.eimce.2026.503030

Diana Ruiz-Cabrera , Francisco Montoya , Joaquín Sáez-Peñataro , José Riera , Pablo Manuel Vargas , Ester López-Suñé , María López-Pont , Marina Martinez-Illán , Alba Catala , Montse Tuset , Irene Fuertes , Xavier Forns , Jose Luis Blanco

Introduction

In the context of the global Mpox outbreak from 2022 to 2024, tecovirimat has been widely used for Mpox treatment, initially demonstrating good tolerance and low toxicity. However, recent studies suggest limited efficacy in reducing Mpox lesions.

Methods

We present the first reported case of significant hepatocellular injury associated with tecovirimat in a patient with Mpox. Pharmacovigilance databases were reviewed to identify any previously reported cases and a literature review was conducted to support the plausibility of this adverse drug reaction.

Results

A 53-year-old man without HIV infection presented with Mpox involving mucocutaneous lesions and suspected encephalitis. Forty-eight hours after initiating tecovirimat, a two-fold increase in liver enzymes was observed. After one week, peak values were recorded: AST 881 U/L, ALT 656 U/L, and LDH 1011 U/L. By the third week, thrombocytopenia (nadir 106,000/mm³) and prolonged prothrombin time (lowest value 55.3%) developed, consistent with moderate liver injury per the US DILIN severity index. Tecovirimat was discontinued on day 7 due to suspected drug-induced liver injury. A thorough evaluation ruled out alternative causes of hepatic damage. Following discontinuation, liver function tests gradually improved, and by week six post-initiation, complete resolution of hepatocellular injury and liver dysfunction was achieved without sequelae.

Conclusions

This case highlights the need for caution when prescribing tecovirimat, particularly given its uncertain clinical efficacy, and stresses the importance of close monitoring for potential hepatotoxic effects.

在2022年至2024年全球Mpox暴发的背景下，tecovirimat已被广泛用于Mpox治疗，初步显示出良好的耐受性和低毒性。然而，最近的研究表明，减少m痘病变的疗效有限。方法：我们报道了首例与替可韦莫相关的显著肝细胞损伤病例。对药物警戒数据库进行了审查，以确定任何先前报告的病例，并对文献进行了回顾，以支持这种药物不良反应的合理性。结果1例53岁男性，未感染HIV，出现m痘，伴粘膜皮肤病变，疑似脑炎。服用替可维明48小时后，观察到肝酶增加两倍。一周后测得峰值：AST 881 U/L， ALT 656 U/L, LDH 1011 U/L。到第三周，出现血小板减少（最低106,000/mm3）和凝血酶原时间延长（最低55.3%），符合美国DILIN严重程度指数的中度肝损伤。由于怀疑药物性肝损伤，在第7天停用替科维莫。彻底的评估排除了肝损伤的其他原因。停药后，肝功能测试逐渐改善，到开始治疗后第6周，肝细胞损伤和肝功能障碍完全消除，无后遗症。结论：本病例强调了在处方替科韦利莫时需要谨慎，特别是考虑到其不确定的临床疗效，并强调了密切监测潜在肝毒性作用的重要性。

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引用次数: 0

Bacteriemia caused by Mycoplasma capricolum in a hematologic patient 血液病患者由支原体引起的菌血症

Enfermedades infecciosas y microbiologia clinica (English ed.)

Pub Date : 2026-02-01 DOI: 10.1016/j.eimce.2026.503028

Diana López , Beatriz Castro , Alina Pérez , Teresa Delgado

引用次数: 0

Human parvovirus B19 infection in immunocompetent adults: A diagnostic challenge due to its multiple clinical manifestations 人细小病毒B19感染免疫功能正常的成年人：由于其多种临床表现的诊断挑战

Enfermedades infecciosas y microbiologia clinica (English ed.)

Pub Date : 2026-02-01 DOI: 10.1016/j.eimce.2026.503054

Raquel Zaragozá González , Carlos de Leonardo Simón , Melisa Hernández Febles , Eduardo Lagarejos González , Iñigo Rúa-Figueroa , María del Val Groba Marco , María del Mar Perera Alvarez , Antonio García Quintana , María José Pena López

Introduction

Human parvovirus B19 (PVB19) is associated with diverse clinical manifestations. While acute infection in immunocompetent adults is generally considered mild, recent European outbreaks and an increase in severe cases highlight the need to always keep this virus in mind. This study aimed to describe the clinical and epidemiological features of acute PVB19 infection in immunocompetent adults requiring hospital care.

Methods

We conducted a retrospective study of immunocompetent patients over 14 years old diagnosed with acute PVB19 infection at a Gran Canaria tertiary hospital (2014–2024). Diagnosis was based on detection of viral DNA and/or specific IgM.

Results

Forty-three patients were included (mean age 40.6 ± 13.9 years; 44.2% male). A marked increase in cases was observed in 2024 (51.2% of total). Clinical manifestations included acute polyarthritis (37.2%), cardiac involvement (34.9%), erythema (16.3%), fever of unknown origin, meningitis, and gastrointestinal symptoms. Cardiac involvement, mostly in males, included dilated cardiomyopathy, pericarditis, and myocarditis, and was associated with two deaths. Hematological abnormalities were frequent (up to 80% in cardiac patients). Two additional patients developed systemic inflammatory diseases. Serological testing alone failed to confirm diagnosis in several cases, needing molecular testing of alternative samples.

Conclusions

Our findings underscore the diverse and potentially severe presentation of PVB19 infection in immunocompetent adults. The high incidence of cardiac involvement and diagnostic challenges highlight the need for enhanced surveillance and clinical awareness. Incorporating PVB19 into differential diagnoses for hospitalized patients with unexplained inflammatory or hematological syndromes may improve timely recognition and management.

人细小病毒B19 （PVB19）具有多种临床表现。虽然在免疫功能正常的成年人中发生急性感染通常被认为是轻微的，但最近欧洲爆发的疫情和严重病例的增加突出表明，需要始终牢记这种病毒。本研究旨在描述需要住院治疗的免疫功能正常的成人急性PVB19感染的临床和流行病学特征。方法对2014-2024年在大加那利岛某三级医院诊断为急性PVB19感染的14岁以上免疫功能正常患者进行回顾性研究。诊断是基于检测病毒DNA和/或特异性IgM。结果纳入43例患者，平均年龄40.6±13.9岁，男性44.2%。2024年病例显著增加（占总数的51.2%）。临床表现包括急性多关节炎（37.2%）、心脏受累（34.9%）、红斑（16.3%）、不明原因发热、脑膜炎和胃肠道症状。心脏受累，主要为男性，包括扩张性心肌病、心包炎和心肌炎，并与2例死亡相关。血液学异常很常见（心脏病患者高达80%）。另外两名患者出现全身性炎症性疾病。在一些病例中，单独的血清学检测无法确诊，需要对其他样本进行分子检测。结论我们的研究结果强调了PVB19感染在免疫功能正常的成年人中的多样性和潜在的严重表现。心脏受累的高发生率和诊断挑战突出了加强监测和临床意识的必要性。将PVB19纳入不明原因炎症或血液学综合征住院患者的鉴别诊断可提高及时识别和管理。

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引用次数: 0

Respiratory syncytial virus infection in non-severely immunocompromised adults: Clinical features and outcomes from a tertiary university hospital in Argentina 非严重免疫功能低下成人呼吸道合胞病毒感染：阿根廷一所三级大学医院的临床特征和结果

Enfermedades infecciosas y microbiologia clinica (English ed.)

Pub Date : 2026-02-01 DOI: 10.1016/j.eimce.2026.503076

Emilse Daniela Diaz Lobo , Emilio Felipe Huaier Arriuazu , Mariana Vaena , Diana Hongn , Jessica del Valle Molina , Diego Hernan Giunta , Gabriela Alejandra Blugerman , Marisa del Lujan Sanchez

Introduction

Respiratory syncytial virus (RSV) is an increasingly recognised cause of morbidity and mortality in older adults. However, data on RSV burden in Latin American countries remain limited. We aim to describe the clinical characteristics and outcomes of RSV infection in non-severely immunocompromised adults receiving care at a tertiary hospital in Argentina.

Methods

We conducted a retrospective cohort study including adults aged ≥60 years, or ≥50 with comorbidities, diagnosed with RSV between January 2013 and December 2019. The primary outcome was clinical status at days 0, 7, and 30 after diagnosis. Secondary outcomes included 30-day mortality, hospitalisation, ICU admission, and healthcare utilisation.

Results

Of 262 patients included (median age: 82 years), 77.5% were hospitalised at diagnosis. The most common symptoms were cough (62.2%) and dyspnea (58.0%), with abnormal chest imaging in 55.8% of cases. Lower respiratory tract infection (LRTI) was present in 63.7% and severe LRTI in 53.4%. At 30 days, only 57.3% had fully recovered. The 30-day all-cause mortality was 7.6%. ICU admission occurred in 27.1% of patients. Factors associated with worse clinical outcomes included age >85 years, history of heart disease, hypoxemia, abnormal imaging, and ICU admission.

Conclusions

RSV infection in adults is associated with a significant clinical burden and considerable functional impairment. At 30 days post-diagnosis, only 57.3% of patients had been discharged and returned to normal activities. These findings underscore the need for improved preventive strategies and strengthened surveillance in this population.

呼吸道合胞病毒（RSV）越来越被认为是老年人发病和死亡的原因。然而，关于拉丁美洲国家RSV负担的数据仍然有限。我们的目的是描述在阿根廷一家三级医院接受治疗的非严重免疫功能低下成人RSV感染的临床特征和结果。方法：我们进行了一项回顾性队列研究，纳入了2013年1月至2019年12月期间诊断为RSV的年龄≥60岁或≥50岁并伴有合并症的成年人。主要结局是诊断后第0、7和30天的临床状况。次要结局包括30天死亡率、住院率、ICU入院率和医疗保健利用率。结果纳入的262例患者（中位年龄：82岁）中，77.5%的患者在诊断时住院。最常见的症状是咳嗽（62.2%）和呼吸困难（58.0%），胸部影像学异常占55.8%。下呼吸道感染（LRTI）占63.7%，重度下呼吸道感染占53.4%。30天后，只有57.3%的患者完全康复。30天全因死亡率为7.6%。27.1%的患者入住ICU。与较差临床结果相关的因素包括年龄（85岁）、心脏病史、低氧血症、异常影像学和ICU入院情况。结论成人srsv感染与显著的临床负担和相当大的功能损害相关。在诊断后30天，只有57.3%的患者出院并恢复正常活动。这些发现强调了在这一人群中改进预防战略和加强监测的必要性。

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引用次数: 0

A rare case of purulent pericarditis secondary to Streptococcus constellatus due to contiguity of a liver lesion under study 一个罕见的继发于星形链球菌的化脓性心包炎病例。

Enfermedades infecciosas y microbiologia clinica (English ed.)

Pub Date : 2026-02-01 DOI: 10.1016/j.eimce.2025.503040

Jordi Martinez-Matencio, Inmaculada Palacios-Garcia, Eduardo Cantón-Puig, José Garnacho-Montero

引用次数: 0

Bictegravir/emtricitabine/tenofovir alafenamide: A review of the real-world experience in Spain within the last five years Bictegravir/emtricitabine/替诺福韦alafenamide：回顾过去五年来西班牙的实际经验

Enfermedades infecciosas y microbiologia clinica (English ed.)

Pub Date : 2026-02-01 DOI: 10.1016/j.eimce.2026.503056

Concha Amador , Juan Ambrosioni , Luz Martín-Carbonero , Carmen Hidalgo-Tenorio , Juan Tiraboschi , Santiago Moreno

Integrase strand inhibitor (INSTI)-based antiretroviral regimens are the preferred choices for treating people with human immunodeficiency virus (PWH). The once-daily single-tablet combination of INSTI bictegravir, co-formulated with emtricitabine and tenofovir alafenamide (BIC/FTC/TAF), has shown effectiveness and good tolerability in randomized clinical trials, both in treatment-naïve (TN) and virologically suppressed patients switched to this regimen. Real-world evidence represents clinical practice and may fill data gaps left by pivotal studies. Based on literature search for real-world studies in Spain within five years, and using clinical trial data as a contextual framework, this narrative review synthesizes observational experience with BIC/FTC/TAF, focusing on the interplay between comorbidities, advanced age, and treatment outcomes from underrepresented subgroups in clinical trials. This fixed-dose combination proved effective and well-tolerated for TN and treatment-experienced PWH, with low virological failure even in difficult-to-treat patients. Low rates of treatment discontinuations due to adverse events or drug-drug interactions aligned with clinical trial findings.

基于整合酶链抑制剂（INSTI）的抗逆转录病毒治疗方案是治疗人类免疫缺陷病毒（PWH）患者的首选方案。每日一次的INSTI bictegravir单片剂联合恩曲他滨和替诺福韦alafenamide （BIC/FTC/TAF）在随机临床试验中显示出有效性和良好的耐受性，无论是treatment-naïve （TN）还是改用该方案的病毒学抑制患者。真实世界的证据代表临床实践，可能填补关键研究留下的数据空白。基于对五年内西班牙真实世界研究的文献检索，并以临床试验数据为背景框架，本叙述性综述综合了BIC/FTC/TAF的观察经验，重点关注临床试验中代表性不足亚组的合并症、高龄和治疗结果之间的相互作用。这种固定剂量组合被证明对TN和治疗经验丰富的PWH有效且耐受性良好，即使在难以治疗的患者中也具有低病毒学失败。由于不良事件或药物-药物相互作用导致的低停药率与临床试验结果一致。

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引用次数: 0

Validation of FEN-COVID phenotypes in hospitalised COVID-19 patients across the first four waves of the pandemic 在大流行的前四波中，住院的COVID-19患者的FEN-COVID表型验证

Enfermedades infecciosas y microbiologia clinica (English ed.)

Pub Date : 2026-02-01 DOI: 10.1016/j.eimce.2026.503059

Maria Giulia Caponcello , María Del Rocío Fernández-Ojeda , Natalia Maldonado , Manuel Diéguez-Serrano , Ana Laura Blanco-Taboada , Paula Olivares Navarro , Adriana Rivera-Sequeiros , Rafael Perera , Jose A. Delgado-Torralbo , Luisa González-Iglesias , Miguel A. Rico-Corral , María Dolores Del Toro , Jesús Rodríguez-Baño , Zaira R. Palacios-Baena , Belén Gutiérrez-Gutiérrez

Introduction

The FEN-COVID study identified 3 clinical phenotypes (PhA, PhB and PhC) in hospital-admitted patients with COVID-19, which were associated with mortality. The aim of this study is to validate the assignment to phenotypes and their association with mortality in two hospitals in Spain across the first 4 waves of the pandemic, including the impact of corticosteroids and anticoagulant drugs.

Methods

A prospective cohort study of patients admitted for COVID-19 in the first 4 waves in two hospitals was performed. Phenotypes were assigned using the FEN-COVID calculator. The primary outcome was 30-day all-cause mortality. Kaplan–Meier (KM) curves were compared using the log-rank test. Multivariate analysis was performed using Cox regression analysis to assess the association of phenotypes with mortality.

Results

1839 patients were included. Of these, 257 patients were identified as PhA, 1451 as PhB and 130 as PhC; their 30-day mortality was 1.9%, 15.4% and 45.4%, respectively. In multivariate analysis and controlling for wave effect, belonging to phenotype B and phenotype C was associated with progressive increased hazards of death. In addition, appropriate treatment with corticosteroids was significantly associated with lower mortality in PhB, while low-molecular weight heparin use was significantly associated with lower mortality in PhB and PhC.

Conclusions

Our results confirmed that the clinical phenotypes identified in the FEN-COVID study were predictive of mortality across all waves studied. Furthermore, we confirmed the importance of identifying the phenotype to which a patient belongs on admission when considering appropriate treatment with corticosteroids and/or anticoagulants.

FEN-COVID研究在入院的COVID-19患者中发现了3种与死亡率相关的临床表型（PhA、PhB和PhC）。本研究的目的是验证西班牙两家医院在大流行前4波中的表型分配及其与死亡率的关系，包括皮质类固醇和抗凝药物的影响。方法对两家医院前4波新冠肺炎住院患者进行前瞻性队列研究。使用FEN-COVID计算器分配表型。主要终点为30天全因死亡率。Kaplan-Meier （KM）曲线比较采用log-rank检验。采用Cox回归分析进行多变量分析，以评估表型与死亡率的关系。结果纳入1839例患者。其中PhA 257例，PhB 1451例，PhC 130例；30天死亡率分别为1.9%、15.4%和45.4%。在多变量分析和波浪效应控制中，属于表型B和表型C与死亡风险的进行性增加相关。此外，适当的皮质类固醇治疗与PhB的较低死亡率显著相关，而低分子量肝素的使用与PhB和PhC的较低死亡率显著相关。结论我们的研究结果证实，在FEN-COVID研究中确定的临床表型可预测所有研究波的死亡率。此外，我们证实了在考虑使用皮质类固醇和/或抗凝剂进行适当治疗时，在入院时确定患者所属表型的重要性。

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引用次数: 0

Dengue serotypes and their severity correlation: A hospital-based observational study 登革热血清型及其严重程度相关性：一项基于医院的观察性研究

Enfermedades infecciosas y microbiologia clinica (English ed.)

Pub Date : 2026-02-01 DOI: 10.1016/j.eimce.2026.503074

Anju Dinkar , Jitendra Singh

Introduction

Dengue virus (DENV) infection can present a range of clinical manifestations, from mild fever to severe complications. Emerging data suggest that specific viral serotypes may influence disease severity. This study aimed to evaluate the circulating DENV serotypes and their correlation with clinical outcomes in hospitalized patients.

Methods

A retrospective, cross-sectional study was conducted at a tertiary care center in northern India from August 2022 to January 2023. Laboratory-confirmed dengue cases (N = 356) were included, and serotyping was performed via nested reverse transcription-polymerase chain reaction (nested RT-PCR). Demographic, clinical, and biochemical data were analyzed. Statistical comparisons and relative risk analyses were performed to identify associations between serotypes and disease severity, including mortality predictors.

Results

Out of the 111 dengue cases, 7 had mixed serotypes. Among the remaining 104 patients, DENV-2 was the predominant serotype (71.2%), followed by DENV-3 (26.9%), DENV-1 (1.9%), and mixed serotypes (6.3%) infections. Overall, 71.2% of patients presented with warning signs, and 28.8% progressed to severe dengue. The highest severe dengue cases were observed in DENV-2 (33.8%) and in mixed DENV-2 & 3 infections (100%). DENV-2 was significantly associated with severe manifestations such as plasma leakage (RR = 24.73, p < 0.001), hemorrhagic rash, and elevated transaminases. Mortality (21.6%) occurred exclusively in DENV-2 and mixed DENV-2 and 3 infections. Predictors of mortality included thrombocytopenia, leucopenia, elevated SGPT/SGOT, and hypoalbuminemia.

Conclusion

DENV-2 is the principal serotype associated with severe dengue and adverse outcomes in this region. Early identification of serotype and key laboratory parameters can improve risk stratification and clinical management, with implications for surveillance and public health response.

登革热病毒（DENV）感染可呈现一系列临床表现，从轻度发热到严重并发症。新出现的数据表明，特定的病毒血清型可能影响疾病的严重程度。本研究旨在评估住院患者流行DENV血清型及其与临床结局的相关性。方法回顾性横断面研究于2022年8月至2023年1月在印度北部的一家三级保健中心进行。纳入实验室确诊登革热病例（N = 356），通过巢式逆转录聚合酶链反应（巢式RT-PCR）进行血清分型。分析人口学、临床和生化数据。进行了统计比较和相对风险分析，以确定血清型与疾病严重程度之间的关联，包括死亡率预测因子。结果111例登革热病例中，混合血清型7例。其余104例患者中，以DENV-2型为主（71.2%），其次是DENV-3型（26.9%）、DENV-1型（1.9%）和混合血清型（6.3%）感染。总体而言，71.2%的患者出现警告信号，28.8%的患者进展为严重登革热。重症登革热病例最高的是DENV-2感染（33.8%）和DENV-2和denv - 3混合感染（100%）。DENV-2与血浆漏出（RR = 24.73, p < 0.001）、出疹和转氨酶升高等严重症状显著相关。死亡率（21.6%）仅发生在DENV-2和DENV-2和3混合感染中。死亡率的预测因素包括血小板减少、白细胞减少、SGPT/SGOT升高和低白蛋白血症。结论denv -2是该地区与严重登革热和不良结局相关的主要血清型。早期识别血清型和关键实验室参数可改善风险分层和临床管理，从而对监测和公共卫生应对产生影响。

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引用次数: 0

Two vaccine-associated measles cases: Transmission or coincidental cases? 两例疫苗相关麻疹病例：传播病例还是偶发病例？

Enfermedades infecciosas y microbiologia clinica (English ed.)

Pub Date : 2026-02-01 DOI: 10.1016/j.eimce.2026.503071

Ana Hernandez-Aceituno , Diana Sanabria Curbelo , Isabel Falcón García , Álvaro Torres Lana , Roque Abián Montesdeoca Melián , Eneko Larumbe-Zabala

Introduction

Measles, a highly contagious airborne disease, has seen a resurgence in Spain despite the successful implementation of vaccination programs. This study examines two cases of vaccine-associated measles in children attending the same nursery school, both of whom received the measles–mumps–rubella vaccine.

Methods

Retrospective descriptive study of two children with vaccine-associated measles in May 2025 on the island of Gran Canaria (Spain).

Results

The first case involved a 12-month-old girl who developed symptoms six days post-vaccination, while the second case, a 13-month-old boy, exhibited symptoms eight days after receiving the vaccine. Both cases were confirmed as genotype A, indicating the vaccine strain. The investigation included extensive contact tracing, identifying 107 close contacts, with vaccinations administered to susceptible individuals. Laboratory tests confirmed measles through polymerase chain reaction (PCR) analysis. The findings highlight the rarity of clinically significant vaccine-associated disease and the absence of evidence for human-to-human transmission of the vaccine strain.

Conclusion

This study underscores the importance of genotyping in distinguishing between vaccine-associated rash illness and wild-type measles, as well as the need for continued vigilance in monitoring vaccine efficacy and outbreak responses. Ultimately, while the possibility of transmission cannot be entirely dismissed, the evidence suggests that these cases are more likely coincidental rather than a result of transmission.

麻疹是一种高度传染性的空气传播疾病，尽管成功实施了疫苗接种计划，但在西班牙仍出现了死灰复燃。本研究调查了在同一所幼儿园就读的儿童中发生的两例与疫苗有关的麻疹病例，他们都接种了麻疹-腮腺炎-风疹疫苗。方法回顾性描述性研究2025年5月西班牙大加那利岛（Gran Canaria） 2例疫苗相关麻疹患儿。结果第一例病例涉及一名12个月大的女孩，她在接种疫苗6天后出现症状，而第二例病例是一名13个月大的男孩，在接种疫苗8天后出现症状。这两例均被确认为基因型A，表明疫苗株。调查包括广泛追踪接触者，确定了107名密切接触者，并对易感个体进行了疫苗接种。实验室检测通过聚合酶链反应（PCR）分析证实麻疹。这些发现强调了临床显著的疫苗相关疾病的罕见性，以及缺乏该疫苗毒株在人与人之间传播的证据。结论本研究强调了基因分型在区分疫苗相关性皮疹疾病和野生型麻疹方面的重要性，以及在监测疫苗疗效和疫情应对方面继续保持警惕的必要性。最终，虽然不能完全排除传播的可能性，但证据表明，这些病例更有可能是巧合，而不是传播的结果。

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引用次数: 0

An unexpected opportunistic infection in a patient with diffuse large B-cell lymphoma 弥漫性大b细胞淋巴瘤患者的意外机会性感染

Enfermedades infecciosas y microbiologia clinica (English ed.)

Pub Date : 2026-02-01 DOI: 10.1016/j.eimce.2026.503061

Claudia Beatriz Pérez González , Isabel Fradejas Villajos , Lucía Villalón Blanco , Leonor Moreno Núñez

引用次数: 0