IJID regions最新文献_第5页

Patterns and predictors of readmission among sepsis survivors in a tertiary emergency department in Ethiopia 埃塞俄比亚三级急诊科败血症幸存者再入院的模式和预测因素

IF 1.7 Q4 INFECTIOUS DISEASES

IJID regions

Pub Date : 2025-11-17 DOI: 10.1016/j.ijregi.2025.100808

Meron H. Biza , Chernet T. Mengistie , Biruk T. Mengistie , Mikiyas G. Teferi , Tsion K. Admas , Nardos B. Feleke , Gadissa B. Tafa , Finot Debebe , Tigist Worku

Objectives

Sepsis is a leading cause of critical illness worldwide. Survivors often suffer long-term physical, cognitive, and psychological impairments. Post-sepsis rehospitalization is common but poorly characterized in low-resource settings. We aimed to determine 30/90/180-day readmission rates and predictors after emergency sepsis in Addis Ababa.

Methods

We conducted a retrospective cohort study of adult patients meeting Sepsis-3 criteria (infection with ≥2-point rise in Sequential Organ Failure Assessment [SOFA]) admitted to a tertiary Ethiopian emergency department from 2019-2021. A modified SOFA score (five parameters) was used to define organ dysfunction, as has been validated for resource-limited settings. We recorded patient demographics, comorbidities (including cardiovascular disease and malignancy), acute severity (modified SOFA, septic shock, intensive care unit admission), microbiology, antibiotic duration, and outcomes. Survivors were followed for 180 days for hospital readmissions at any site of suspected infection. Multivariable logistic regression identified factors independently associated with 180-day readmission.

Results

Of 110 sepsis patients, 39 (35.5%) died during index admission. Among 71 survivors, 32 (45.1%) were readmitted within 180 days (78.1% within 30 days; 15.6% days 31-90; 6.3% days 91-180). Infectious diagnoses accounted for 71.9% of readmissions (often recurrent pneumonia or urinary tract infection). Median time to first readmission was 16 days (interquartile range 5-41). Multivariable analysis showed higher odds of 180-day readmission in younger patients (adjusted odds ratio [OR] 2.53 per decade decrease in age, 95% confidence interval 1.09-5.87, P = 0.029), and lower odds in those with non-metastatic malignancy (adjusted OR 0.15, 0.03-0.75, P = 0.027) or longer index hospitalization (adjusted OR 0.31 per 5-day increase, 0.11-0.89, P = 0.033).

Conclusions

Nearly half of emergency sepsis survivors were readmitted within 180 days, predominantly within 30 days, and most readmissions were for infection. Predictors included younger age, malignancy status, and length of stay. These findings highlight the need for targeted discharge planning, antimicrobial stewardship, and early follow-up for high-risk patients in low-resource settings.

脓毒症是世界范围内严重疾病的主要原因。幸存者经常遭受长期的身体、认知和心理损伤。脓毒症后再住院很常见，但在资源匮乏的地区特征不佳。我们的目的是确定亚的斯亚贝巴急诊败血症后30/90/180天的再入院率和预测因素。方法：我们对2019-2021年在埃塞俄比亚三级急诊科就诊的符合脓毒症-3标准（连续器官衰竭评估[SOFA]感染上升≥2点）的成年患者进行了回顾性队列研究。一个改进的SOFA评分（五个参数）被用来定义器官功能障碍，这在资源有限的情况下已经得到验证。我们记录了患者的人口统计、合并症（包括心血管疾病和恶性肿瘤）、急性严重程度（改良SOFA、感染性休克、重症监护病房入院）、微生物学、抗生素持续时间和结果。对幸存者进行了180天的随访，以便在任何怀疑感染的地点再次住院。多变量logistic回归确定了与180天再入院独立相关的因素。结果110例败血症患者中，39例（35.5%）在入院时死亡。71例幸存者中，32例（45.1%）在180天内再次入院（30天内78.1%，31-90天15.6%，91-180天6.3%）。感染诊断占再入院的71.9%（通常是复发性肺炎或尿路感染）。到首次再入院的中位时间为16天（四分位数范围5-41）。多变量分析显示，年轻患者180天再入院的几率较高（校正比值比[OR] 2.53 / 10年，95%可信区间1.09-5.87,P = 0.029），而非转移性恶性肿瘤患者（校正比值比[OR] 0.15, 0.03-0.75, P = 0.027）或指数住院时间较长的患者（校正比值比[OR] 0.31 / 5天，0.11-0.89,P = 0.033）的再入院几率较低。结论近一半的急诊脓毒症幸存者在180天内再次入院，主要是在30天内，大多数是因感染再次入院。预测因素包括年龄较小、恶性肿瘤状态和住院时间。这些发现强调了有针对性的出院计划、抗菌药物管理和对低资源环境中高风险患者的早期随访的必要性。

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引用次数: 0

Candidemia in the intensive care unit before and during the COVID-19 pandemic: a cross-sectional analysis COVID-19大流行之前和期间重症监护病房中的念珠菌：横断面分析

IF 1.7 Q4 INFECTIOUS DISEASES

IJID regions

Pub Date : 2025-11-16 DOI: 10.1016/j.ijregi.2025.100807

Suzan Şahin , Elif Bombacı , Bülent Kaya , Serap Demir Tekol

Objectives

Increased incidences of candidemia have been reported among intensive care unit (ICU) patients during the COVID-19 pandemic.

Methods

The study included adult patients diagnosed with candidemia in the ICU during two periods from January 1, 2017, to December 31, 2022, that were separated by the in-country declaration of COVID-19. We evaluated the incidences of candidemia during two periods marked by transformation of an old tertiary hospital into a completely new and modern facility, which took place just before the emergence of the pandemic.

Results

During the pre-COVID-19 and COVID-19 periods, 3796 and 10,467 patients were admitted to the ICU, of whom 61 (1.6%, incidence 2.03 per 1000 ICU-days) and 62 (0.6%, incidence 0.66 per 1000 ICU-days) patients developed candidemia, respectively. The median time to candidemia detection was significantly longer in the COVID-19 period (34 vs 29 days, P = 0.022). During the pre-COVID-19 period, Candida parapsilosis (68.9% vs 37.1%) was the most predominant species, which was superseded during the COVID-19 period by C. albicans (35.5% vs 16.4%). Fluconazole resistance was significantly lower in the COVID-19 period (14.5% vs 31.1%, P = 0.027), with a lower resistance rate of C. parapsilosis (21.7% vs 38.1%). Of 3,094 (29.6%) patients with COVID-19, candidemia developed in nine patients ( 0.29%) as compared with 53 patients (0.72%) without COVID-19.

Conclusions

Despite reports on increased incidences of candidemia among ICU patients during the COVID-19 period, lower incidences of candidemia found in the present study both during the COVID-19 period and among COVID-19 patients may be attributed to the complete transformation of our facility.

目的在2019冠状病毒病大流行期间，重症监护病房（ICU）患者中念珠菌的发病率有所上升。方法本研究纳入2017年1月1日至2022年12月31日在ICU诊断为念珠菌病的成年患者，这两个时期被国内COVID-19申报分开。我们对两个时期的念珠菌病发病率进行了评估，这两个时期的标志是在大流行出现之前将一个旧的三级医院改造为一个全新的现代化设施。结果2019冠状病毒病前期和2019冠状病毒病期间，分别有3796例和10467例患者入住ICU，其中61例（1.6%，发病率2.03 / 1000 ICU-d）和62例（0.6%，发病率0.66 / 1000 ICU-d）发生念珠菌病。在COVID-19期间，检测到念珠菌的中位时间明显更长（34天vs 29天，P = 0.022）。在2019冠状病毒病前，假丝酵母菌（68.9%比37.1%）是最占优势的菌种，在2019冠状病毒病前，白色念珠菌（35.5%比16.4%）取代了假丝酵母菌。新冠肺炎期间氟康唑耐药率较低（14.5% vs 31.1%, P = 0.027），其中副疏僵菌耐药率较低（21.7% vs 38.1%）。在3094例（29.6%）COVID-19患者中，9例（0.29%）患者出现念珠菌，而未出现COVID-19的患者为53例（0.72%）。结论尽管有报道称2019冠状病毒病期间ICU患者中念珠菌的发病率有所增加，但本研究中发现的2019冠状病毒病期间和2019冠状病毒病患者中念珠菌的发病率均较低，这可能归因于我们设施的彻底改造。

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引用次数: 0

Long-lasting insecticidal nets, arboviral risks, and ecological vector shifts in refugee settings 长效驱虫蚊帐、虫媒病毒风险以及难民环境中的生态媒介转移

IF 1.7 Q4 INFECTIOUS DISEASES

IJID regions

Pub Date : 2025-11-16 DOI: 10.1016/j.ijregi.2025.100809

Giancarlo Ceccarelli , Francesco Branda , Fabio Scarpa , Marta Giovanetti , Massimo Ciccozzi

引用次数: 0

Epidemiological investigation and public health response to a diphtheria outbreak in Jalalabad Union, Sylhet, December 2023 2023年12月锡尔赫特贾拉拉巴德联盟白喉疫情流行病学调查和公共卫生应对

IF 1.7 Q4 INFECTIOUS DISEASES

IJID regions

Pub Date : 2025-11-16 DOI: 10.1016/j.ijregi.2025.100805

Md. Mainul Hassan, Sohel Rahman, Md Foyjul Islam, Sadia Sultana, Md. Ahashan Habib, Mohammad Rashedul Hassan, Md. Omar Qayum, Manjur Hossain Khan Jony, Zakir Hossain Habib, Ahmed Nawsher Alam, Mahbubur Rahman, Tahmina Shirin

Objectives

Diphtheria incidence has significantly declined globally due to the Expanded Program on Immunization, yet breakthrough infections occur due to waning immunity in late childhood. Since 2010, Bangladesh has reported 148 cases. On December 10, 2023, a suspected diphtheria case was reported to the Institute of Epidemiology, Disease Control and Research, prompting an epidemiological investigation and public health response.

Methods

Following World Health Organization guidelines, the team identified suspected and confirmed cases, conducted interviews with the index case and contacts, and collected samples for polymerase chain reaction testing. Risk communication and active case searches were carried out in the affected area.

Results

The index case, a 10-year-old girl with classic diphtheria symptoms, was hospitalized for 15 days and recovered after receiving antibiotics and diphtheria antitoxin (DAT). Among 25 close contacts, 14 (56%) were suspected cases, and two (8%) were confirmed via polymerase chain reaction; these two positive cases were siblings of the index case and were previously vaccinated. Chemoprophylaxis, vaccination, isolation, and quarantine were implemented, although the two later confirmed cases did not receive DAT due to unavailability.

Conclusions

Despite a high average coverage rate of 95% (2018-2022) for Penta 3, the outbreak revealed potential waning immunity or vaccine failure. The outbreak was effectively contained through timely confirmation, contact tracing, prophylactic antibiotics, immunization, and quarantine. Booster doses, quantification of antibody titer, and DAT access remain critical.

目的由于扩大免疫规划的实施，白喉发病率在全球范围内显著下降，但由于儿童后期免疫力下降，出现了突破性感染。自2010年以来，孟加拉国报告了148例病例。2023年12月10日，向流行病学、疾病控制和研究所报告了一起疑似白喉病例，促使开展流行病学调查和公共卫生应对。方法按照世界卫生组织的指导方针，该小组确定了疑似病例和确诊病例，对指示病例和接触者进行了访谈，并收集了用于聚合酶链反应检测的样本。在受影响地区进行了风险沟通和积极的病例搜索。结果指示病例为10岁女童，典型白喉症状，住院15 d，经抗生素和白喉抗毒素治疗后痊愈。25例密切接触者中，疑似病例14例（56%），经聚合酶链反应确诊2例（8%）；这两例阳性病例是指示病例的兄弟姐妹，以前曾接种过疫苗。实施了化学预防、疫苗接种、隔离和检疫，但后来确诊的两例病例由于无法获得疫苗而未接受DAT治疗。结论尽管Penta - 3的平均覆盖率高达95%(2018-2022)，但疫情显示可能出现免疫力下降或疫苗失败的情况。通过及时确诊、追踪接触者、预防性抗生素、免疫接种和隔离等措施，疫情得到有效控制。加强剂量、抗体滴度定量和DAT获取仍然至关重要。

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引用次数: 0

Tetanus Toxoid Vaccine Uptake and Associated Factors Among Reproductive Age Women in Mogadishu, Somalia: A Cross-Sectional Study 索马里摩加迪沙育龄妇女破伤风类毒素疫苗接种及其相关因素：一项横断面研究

IF 1.7 Q4 INFECTIOUS DISEASES

IJID regions

Pub Date : 2025-11-13 DOI: 10.1016/j.ijregi.2025.100804

Amina Abukar Abdulle , Shafie Abdulkadir Hassan

Objectives

Maternal and neonatal tetanus (MNT) remains a major public health concern in Somalia, where health infrastructure is still recovering. Despite the availability of a safe and effective tetanus toxoid (TT) vaccine, coverage remains low. This study aimed to identify factors influencing TT vaccine uptake among reproductive-age women in Mogadishu, Somalia.

Methods

A community-based cross-sectional study was conducted from June to August 2025 in Mogadishu, Somalia. A two-stage cluster sampling technique combined with systematic random sampling was used to select 350 households. Data were collected using a structured, interviewer-administered questionnaire, and the primary outcome was adherence to at least two doses of the TT vaccine during pregnancy. Data were analyzed using bivariate and multivariable logistic regression to identify independent predictors of TT vaccine uptake.

Results

A total of 350 women participated in the study. Coverage of the TT vaccine was low, with only 19.7% receiving two or more doses during their last pregnancy. Multivariate analysis showed that women aged 36-49 years were more likely to be protected compared to those aged 15-25 years (AOR = 6.62; 95% confidence interval [CI]: 1.74-25.21; P = 0.006). Planned pregnancy was associated with higher protection (AOR = 8.35; 95% CI: 3.25-21.45; P <0.001). Attendance at health centers for antenatal care (AOR = 0.35; 95% CI: 0.18-0.69; P = 0.002), visits by health extension workers (AOR = 8.13; 95% CI: 4.35-15.22; P <0.001), and good behavior of health workers (AOR = 3.48; 95% CI: 1.15-10.46; P = 0.027) were positively associated with TT protection. Women from households with a monthly income below 57 US$ were significantly less likely to be protected (AOR = 0.04; 95% CI: 0.01-0.22; P <0.001).

Conclusions

TT vaccination coverage among women was low. Older age, planned pregnancy, antenatal care at health centers, visits by health extension workers, and good behavior of health workers were associated with higher protection, while low household income was linked to lower uptake. Strengthening targeted interventions is needed to improve TT coverage.

在卫生基础设施仍在恢复的索马里，孕产妇和新生儿破伤风仍然是一个主要的公共卫生问题。尽管有安全有效的破伤风类毒素疫苗，但覆盖率仍然很低。本研究旨在确定影响索马里摩加迪沙育龄妇女接种破伤风疫苗的因素。方法于2025年6 - 8月在索马里摩加迪沙进行了一项以社区为基础的横断面研究。采用两阶段整群抽样与系统随机抽样相结合的方法，选取了350户家庭。数据是通过结构化的访谈问卷收集的，主要结果是在怀孕期间坚持接种至少两剂TT疫苗。使用双变量和多变量逻辑回归分析数据，以确定TT疫苗摄取的独立预测因素。结果共有350名女性参与了这项研究。破伤风破伤风疫苗的覆盖率很低，只有19.7%的人在最后一次怀孕期间接种了两次或两次以上的疫苗。多因素分析显示，与15-25岁的女性相比，36-49岁的女性更有可能受到保护（AOR = 6.62； 95%可信区间[CI]: 1.74-25.21; P = 0.006）。计划妊娠与较高的保护相关（AOR = 8.35; 95% CI: 3.25-21.45; P <0.001）。到保健中心接受产前护理的人数（AOR = 0.35; 95% CI: 0.18-0.69; P = 0.002）、卫生推广工作者的就诊人数（AOR = 8.13; 95% CI: 4.35-15.22; P <0.001）和卫生工作者的良好行为（AOR = 3.48; 95% CI: 1.15-10.46; P = 0.027）与TT保护呈正相关。来自月收入低于57美元家庭的妇女得到保护的可能性明显较低（AOR = 0.04; 95% CI: 0.01-0.22; P <0.001）。结论妇女性传播疾病疫苗接种率低。年龄较大、计划怀孕、保健中心的产前护理、保健推广工作者的就诊以及保健工作者的良好行为与较高的保护程度有关，而家庭收入较低与较低的保护程度有关。需要加强有针对性的干预措施，以改善TT覆盖。

{"title":"Tetanus Toxoid Vaccine Uptake and Associated Factors Among Reproductive Age Women in Mogadishu, Somalia: A Cross-Sectional Study","authors":"Amina Abukar Abdulle , Shafie Abdulkadir Hassan","doi":"10.1016/j.ijregi.2025.100804","DOIUrl":"10.1016/j.ijregi.2025.100804","url":null,"abstract":"<div><h3>Objectives</h3><div>Maternal and neonatal tetanus (MNT) remains a major public health concern in Somalia, where health infrastructure is still recovering. Despite the availability of a safe and effective tetanus toxoid (TT) vaccine, coverage remains low. This study aimed to identify factors influencing TT vaccine uptake among reproductive-age women in Mogadishu, Somalia.</div></div><div><h3>Methods</h3><div>A community-based cross-sectional study was conducted from June to August 2025 in Mogadishu, Somalia. A two-stage cluster sampling technique combined with systematic random sampling was used to select 350 households. Data were collected using a structured, interviewer-administered questionnaire, and the primary outcome was adherence to at least two doses of the TT vaccine during pregnancy. Data were analyzed using bivariate and multivariable logistic regression to identify independent predictors of TT vaccine uptake.</div></div><div><h3>Results</h3><div>A total of 350 women participated in the study. Coverage of the TT vaccine was low, with only 19.7% receiving two or more doses during their last pregnancy. Multivariate analysis showed that women aged 36-49 years were more likely to be protected compared to those aged 15-25 years (AOR = 6.62; 95% confidence interval [CI]: 1.74-25.21; <em>P</em> = 0.006). Planned pregnancy was associated with higher protection (AOR = 8.35; 95% CI: 3.25-21.45; <em>P</em> <0.001). Attendance at health centers for antenatal care (AOR = 0.35; 95% CI: 0.18-0.69; <em>P</em> = 0.002), visits by health extension workers (AOR = 8.13; 95% CI: 4.35-15.22; <em>P</em> <0.001), and good behavior of health workers (AOR = 3.48; 95% CI: 1.15-10.46; <em>P</em> = 0.027) were positively associated with TT protection. Women from households with a monthly income below 57 US$ were significantly less likely to be protected (AOR = 0.04; 95% CI: 0.01-0.22; <em>P</em> <0.001).</div></div><div><h3>Conclusions</h3><div>TT vaccination coverage among women was low. Older age, planned pregnancy, antenatal care at health centers, visits by health extension workers, and good behavior of health workers were associated with higher protection, while low household income was linked to lower uptake. Strengthening targeted interventions is needed to improve TT coverage.</div></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":"18 ","pages":"Article 100804"},"PeriodicalIF":1.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Resurgence of multistate cholera in Sudan amidst ongoing conflict 在持续冲突中，苏丹多州霍乱死灰复燃

IF 1.7 Q4 INFECTIOUS DISEASES

IJID regions

Pub Date : 2025-11-01 DOI: 10.1016/j.ijregi.2025.100798

Ayman Azhary , Nooh Mohamed Hajhamed , Rana Mohamed , Eman Taha Osman Ali , Mohammed Elfatih Hamida , Claude Mambo Muvunyi , Emmanuel Edwar Siddig

Objectives

This study describes the changing trends of multistate cholera outbreaks in Sudan during the ongoing conflict.

Methods

This was a retrospective cross-sectional study based on cholera surveillance data available at the national level (from August 2023 to June 2025). Case fatality rates (CFRs) annually and per state were obtained, and the data were analyzed using R program 4.2.2 (Version 2025.05.1+513). The study used the anonymous secondary data provided by the Surveillance Directorate dashboard.

Results

In 2023, a total of 9581 cases and 254 fatalities (overall CFR of 2.7%) were reported in 10 states. The Red Sea state recorded the highest number of cases (n = 3379, with 101 deaths and a CFR of 3%). Then 2024 recorded the highest number of cases and fatalities (n = 50,832, with 1380 deaths and a CFR of 2.7%), compared to 2023 and the first half of 2025 (n = 23,488 cases, with 517 deaths and a CFR of 1.7%). Regarding the overall trend per state, Khartoum, White Nile, and the North Kordofan states showed an increasing trend between August 2023 and June 2025, while the Red Sea, Al Jazirah, Al Qadarif, and Kassala states showed a decreasing trend.

Conclusions

The findings underscore the complex dynamics of cholera transmission influenced by conflict-related water and sanitation disruptions, displacement, and vaccination efforts. The dramatic (>5-fold) increase in cases from 2023 to 2024, followed by a declining CFR in 2025, suggests that although the outbreak surged quickly, interventions may have ultimately improved case outcomes. Continued surveillance, targeted interventions, and health infrastructure strengthening are paramount to controlling current outbreaks and preventing future resurgence in conflict-affected regions.

目的本研究描述了苏丹持续冲突期间多州霍乱暴发的变化趋势。方法本研究是一项基于国家层面现有霍乱监测数据（2023年8月至2025年6月）的回顾性横断面研究。获得每年和每个州的病死率（CFRs），并使用R程序4.2.2 （Version 2025.05.1+513）对数据进行分析。这项研究使用了监视理事会仪表板提供的匿名次要数据。结果2023年，10个州共报告病例9581例，死亡254例，总病死率2.7%。红海州记录的病例数最多（3379例，101例死亡，病死率为3%）。与2023年和2025年上半年相比，2024年的病例和死亡人数最多（n = 50,832，死亡人数为1380，病死率为2.7%）（n = 23,488，死亡人数为517，病死率为1.7%）。就每个州的总体趋势而言，喀土穆、白尼罗河和北科尔多凡州在2023年8月至2025年6月期间呈上升趋势，而红海、Al Jazirah、Al Qadarif和Kassala州呈下降趋势。结论：研究结果强调了霍乱传播的复杂动态，受冲突相关的水和卫生设施中断、流离失所和疫苗接种工作的影响。从2023年到2024年，病例急剧增加（5倍），随后在2025年病死率下降，这表明尽管疫情迅速爆发，但干预措施可能最终改善了病例结果。持续监测、有针对性的干预措施和加强卫生基础设施对于控制当前疫情和防止未来在受冲突影响地区卷土重来至关重要。

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引用次数: 0

Fifteen years of tuberculosis and HIV diagnostic services in Brazil: disruption, regional disparities, and recovery before, during, and after the COVID-19 pandemic 巴西结核病和艾滋病毒诊断服务的15年：COVID-19大流行之前、期间和之后的中断、区域差异和恢复

IF 1.7 Q4 INFECTIOUS DISEASES

IJID regions

Pub Date : 2025-10-31 DOI: 10.1016/j.ijregi.2025.100796

Luanne Karolyne Leal dos Santos , Yan Mathias Alves , Reginaldo Bazon Vaz Tavares , Marcela Antunes Paschoal Popolin , Nathalia Zini , Ione Carvalho Pinto , Pedro Fredemir Palha , Aline Aparecida Monroe , Erica Chimara , Ricardo Alexandre Arcêncio

Objectives

This study analyzes fifteen years of nationwide trends and regional disparities in tuberculosis (TB) and HIV diagnostics in Brazil, examining the impacts of the COVID-19 pandemic and the uneven recovery of diagnostic services across different regions.

Methods

This nationwide ecological study analyzed monthly data on TB and HIV diagnostic tests performed in Brazil from 2010 to 2024, utilizing real-world data. Temporal trends and interrupted time-series analyses evaluated the immediate and progressive effects of the COVID-19 pandemic. Spatial patterns and autocorrelation were explored using bivariate Moran’s I and Kernel density estimation.

Results

Results showed significant abrupt declines during the COVID-19 pandemic for smear microscopy (–16.4%), culture (–21.4%), and HIV (–16.2%). Post-pandemic, Xpert MTB/RIF showed the highest monthly increase (+3.8%; 95% confidence interval: 2.9-4.7), while smear microscopy declined (–1.2%; 95% confidence interval: –2.0 to –0.5). Spatial analysis revealed pronounced regional heterogeneity, with Northern and Northeastern municipalities facing the greatest disruptions. The Xpert MTB/RIF test demonstrated greater resilience, with evident growth in its distribution and implementation over time. However, this increase resulted in a decrease in the conduction of smear microscopy tests and highlighted territorial disparities, since only 167 municipalities (3%) have Xpert MTB/RIF assays, mainly in the Southeast.

Conclusions

COVID-19 significantly disrupted traditional TB and HIV diagnostics in Brazil, while there was an evident increase and resilience of Xpert MTB/RIF, reducing the use of smear microscopy tests. Policy efforts should prioritize the equitable expansion of molecular diagnostic technologies across all regions. This approach will improve early TB detection and drug resistance testing, thereby reducing diagnostic disparities and strengthening health system resilience toward achieving the End TB Strategy.

本研究分析了巴西15年来结核病和艾滋病毒诊断的全国趋势和地区差异，考察了COVID-19大流行的影响以及不同地区诊断服务恢复的不平衡。方法：这项全国性的生态学研究分析了2010年至2024年在巴西进行的结核病和艾滋病毒诊断检测的月度数据，利用了真实世界的数据。时间趋势和中断时间序列分析评估了COVID-19大流行的即时和渐进影响。利用二元Moran 's I和核密度估计探索空间模式和自相关性。结果在COVID-19大流行期间，涂片镜检（-16.4%）、培养（-21.4%）和HIV（-16.2%）呈显著性突然下降。大流行后，Xpert MTB/RIF的月增长率最高（+3.8%；95%可信区间：2.9-4.7），而涂片镜检下降（-1.2%；95%可信区间：-2.0至-0.5）。空间分析显示出明显的区域异质性，北部和东北部城市面临的破坏最大。Xpert MTB/RIF测试显示出更大的弹性，随着时间的推移，其分布和实施明显增长。然而，这一增加导致涂片显微镜检查的进行减少，并突出了地区差异，因为只有167个城市（3%）有专家MTB/RIF检测，主要在东南部。结论2019冠状病毒病疫情严重破坏了巴西传统的结核病和艾滋病毒诊断方法，而Xpert MTB/RIF检测方法明显增加和恢复力，减少了涂片镜检的使用。政策努力应优先考虑在所有区域公平推广分子诊断技术。这一方法将改善早期结核病检测和耐药性检测，从而缩小诊断差异，并加强卫生系统抵御能力，朝着实现《终止结核病战略》的目标迈进。

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引用次数: 0

Spatial heterogeneities in women’s adherence to sulfadoxine pyrimethamine prophylaxis in Tanzania: Findings from the 2022 TDHS–MIS 坦桑尼亚妇女对磺胺多辛乙胺嘧啶预防依从性的空间异质性：来自2022年TDHS-MIS的调查结果

IF 1.7 Q4 INFECTIOUS DISEASES

IJID regions

Pub Date : 2025-10-30 DOI: 10.1016/j.ijregi.2025.100795

Mbwiga Sote Aloni

Objectives

Most pregnant women in Tanzania do not adhere to the recommended use of SP/Fansidar for malaria prevention, posing a significant challenge to malaria control efforts. The study examines zonal heterogeneities in the uptake of SP/Fansidar doses in Tanzania.

Methods

This cross-sectional study analyzed 2022 TDHS-MIS data to examine sociodemographic and geographic determinants of sufficient SP/Fansidar uptake among pregnant women in Tanzania.

Results

Among 4157 women aged 15-49, those with secondary or higher education were 1.37 times more likely to take three or more SP/Fansidar doses, while women aged 35-39 were 34% less likely than those aged 15-19. SP/Fansidar doses uptake was higher in the Northern (adjusted odds ratio [aOR] = 1.78), Lake (aOR = 1.57), Southern (aOR = 1.44), and Eastern (aOR = 1.38) zones but 73% lower in Zanzibar (aOR = 0.27).

Conclusions

Uptake of ≥3 SP/Fansidar doses among women in Tanzania remains generally low, with significant disparities across geographic zones and sociodemographic groups. The Northern, Southern, Lake, and Eastern zones show higher coverage, while Zanzibar lags substantially behind. Factors such as place of residence, education, maternal age, wealth status, and parity are key determinants, underscoring the need for carefully designed, geographically targeted interventions to improve SP/Fansidar adherence in the most affected zones.

坦桑尼亚大多数孕妇没有按照建议使用SP/Fansidar预防疟疾，这对疟疾控制工作构成了重大挑战。该研究考察了坦桑尼亚SP/Fansidar剂量摄取的地域性异质性。方法：本横断面研究分析了2022年TDHS-MIS数据，以检查坦桑尼亚孕妇充分服用SP/Fansidar的社会人口统计学和地理因素。结果在4157名15-49岁的女性中，受过中等或高等教育的女性服用三剂或更多SP/Fansidar的可能性是15-19岁女性的1.37倍，而35-39岁女性的可能性比15-19岁女性低34%。SP/Fansidar剂量摄取在北部（校正优势比[aOR] = 1.78）、湖区（aOR = 1.57）、南部（aOR = 1.44）和东部（aOR = 1.38）地区较高，但在桑给巴尔（aOR = 0.27）低73%。结论：坦桑尼亚妇女服用≥3 SP/Fansidar剂量仍然普遍较低，在地理区域和社会人口群体之间存在显著差异。北部、南部、湖区和东部地区的覆盖率较高，而桑给巴尔则远远落后。居住地、教育程度、产妇年龄、财富状况和性别平等等因素是关键决定因素，因此需要精心设计、有地理针对性的干预措施，以改善受影响最严重地区的SP/Fansidar依从性。

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引用次数: 0

First documented case of imported human babesiosis in Honduras: Diagnostic challenges with malaria falciparum 洪都拉斯首例记录在案的输入性人类巴贝斯虫病：恶性疟疾的诊断挑战

IF 1.7 Q4 INFECTIOUS DISEASES

IJID regions

Pub Date : 2025-10-29 DOI: 10.1016/j.ijregi.2025.100794

Lesly Chaver , Heydi Flores , Wendy Padilla , Jenny Rodríguez , Concepción Zúniga , Francisco Medina , Gabriela Matamoros , María Esther Araujo , Bryan Ortiz , Gustavo Fontecha

Human babesiosis is an emerging zoonosis that can mimic Plasmodium falciparum malaria, often leading to misdiagnosis in malaria-endemic regions. We report the first confirmed case of imported babesiosis in Honduras. A 72-year-old man returned from Massachusetts and developed fever, neurological symptoms, and ischemic stroke. Thick smears suggested P. falciparum; he was treated with chloroquine–primaquine followed by artemether–lumefantrine, but hyperparasitemia persisted and he developed multiorgan failure, dying on day 33. Molecular assays were negative for Plasmodium but polymerase chain reaction confirmed Babesia 18S rRNA. Retrospective smear review identified the Maltese cross. This fatal case illustrates the diagnostic challenge of distinguishing babesiosis from malaria and underscores the need to consider babesiosis in febrile travelers unresponsive to antimalarials. Strengthening molecular diagnostic capacity is essential in malaria-endemic regions.

人类巴贝斯虫病是一种新兴的人畜共患病，可模仿恶性疟原虫疟疾，在疟疾流行地区常常导致误诊。我们报告洪都拉斯首例输入性巴贝斯虫病确诊病例。一名72岁男子从马萨诸塞州返回，出现发烧、神经系统症状和缺血性中风。厚涂片提示恶性疟原虫；患者先后接受氯喹-伯氨喹和蒿甲醚-氨苯曲明治疗，但高寄生虫血症持续存在，并发多器官功能衰竭，于第33天死亡。分子检测结果为疟原虫阴性，聚合酶链反应证实为巴贝斯虫18S rRNA。回顾性涂片检查确定了马耳他十字。这一致命病例说明了将巴贝斯虫病与疟疾区分开来的诊断挑战，并强调需要考虑对抗疟药物无反应的发热旅行者中的巴贝斯虫病。在疟疾流行地区，加强分子诊断能力至关重要。

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引用次数: 0

Predicting 7-day mortality in COVID-19 pneumonia: performance of NEWS2, qSOFA, and CRB-65 and development of the CCP-7 prediction scores 预测COVID-19肺炎的7天死亡率：NEWS2、qSOFA和CRB-65的表现以及CCP-7预测评分的制定

IF 1.7 Q4 INFECTIOUS DISEASES

IJID regions

Pub Date : 2025-10-24 DOI: 10.1016/j.ijregi.2025.100792

Panika Praputpittaya , Areeya Phunsupruk , Piyapat Rattanasuwan , Borwon Wittayachamnankul , Wachira Wongtanasarasin

Objectives

Effective early risk stratification of COVID-19 pneumonia patients in emergency departments (EDs) is crucial, especially in resource-limited settings. Common clinical scores (National Early Warning Score version 2 [NEWS2], quick Sequential Organ Failure Assessment [qSOFA], and CRB-65) were not developed for COVID-19 and may inadequately predict short-term mortality. This study aimed to evaluate the prognostic performance of these scores and to develop and internally validate a novel score—the Chiang Mai COVID-19 Pneumonia 7-Day Mortality Prediction Score (CCP-7).

Methods

We conducted a retrospective cohort study of patients aged ≥16 years presenting to a tertiary ED in Northern Thailand with confirmed COVID-19 pneumonia between January 2020 and December 2023. Demographic, clinical, and laboratory data were extracted from electronic records. The predictive accuracy of NEWS2, qSOFA, CRB-65, and the newly developed CCP-7 score for 7-day mortality was assessed using a regression framework, the area under the receiver operating characteristic curve (AUROC), calibration, and DeLong tests for AUROC comparisons.

Results

Among 735 patients included, the 7-day mortality rate was 5.2%. Four variables—respiratory rate greater than 30/min, altered mental status, abnormal white blood cell count, and thrombocytopenia—were independently associated with mortality and incorporated into the CCP-7. The CCP-7 score demonstrated superior discrimination (AUROC, 0.83; 95% confidence interval [CI]: 0.76-0.90) compared to CRB-65 (0.80, 95% CI: 0.74-0.86), NEWS2 (0.77, 95% CI: 0.68-0.85), and qSOFA (0.64, 95% CI: 0.52-0.75). DeLong tests showed no statistically significant differences between CCP-7 and CRB-65 or NEWS2. At a cutoff of ≥3 points, CCP-7 achieved 57.1% sensitivity and 89.4% specificity.

Conclusions

CCP-7 is a simple and context-appropriate tool for predicting 7-day mortality in patients with COVID-19 pneumonia. Although it showed numerically higher discrimination than other scores, the differences were not statistically significant. Its reliance on routine ED parameters makes it particularly suited for rapid risk stratification in low-resource settings, but external validation is essential.

目的对急诊COVID-19肺炎患者进行有效的早期风险分层至关重要，特别是在资源有限的情况下。常见的临床评分（国家早期预警评分版本2 [NEWS2]、快速顺序器官衰竭评估[qSOFA]和CRB-65）未针对COVID-19开发，可能无法充分预测短期死亡率。本研究旨在评估这些评分的预后表现，并开发和内部验证一种新的评分-清迈COVID-19肺炎7天死亡率预测评分（CCP-7）。方法：我们对2020年1月至2023年12月期间在泰国北部确诊COVID-19肺炎的三级急诊科就诊的年龄≥16岁的患者进行了回顾性队列研究。从电子记录中提取人口统计、临床和实验室数据。采用回归框架、受试者工作特征曲线下面积（AUROC）、校准和用于AUROC比较的DeLong检验评估NEWS2、qSOFA、CRB-65和新开发的CCP-7评分对7天死亡率的预测准确性。结果735例患者7天死亡率为5.2%。呼吸频率大于30/min、精神状态改变、白细胞计数异常和血小板减少这四个变量与死亡率独立相关，并被纳入CCP-7。与CRB-65 （0.80, 95% CI: 0.74-0.86）、NEWS2 （0.77, 95% CI: 0.68-0.85）和qSOFA （0.64, 95% CI: 0.52-0.75）相比，CCP-7评分表现出更强的辨别性（AUROC, 0.83； 95%可信区间[CI]: 0.76-0.90）。德隆试验显示CCP-7与CRB-65或NEWS2之间无统计学差异。在≥3点的截止点上，CCP-7的敏感性为57.1%，特异性为89.4%。结论sccp -7是预测COVID-19肺炎患者7天死亡率的一种简单且适合情境的工具。虽然它在数字上比其他分数显示出更高的歧视，但差异在统计上并不显著。它对常规ED参数的依赖使其特别适合于低资源环境下的快速风险分层，但外部验证是必不可少的。

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引用次数: 0