Infectious diseases (London, England)最新文献

Background: Spinal epidural abscess (SEA) is a serious complication of Staphylococcus aureus bacteraemia (SAB) that can be difficult to diagnose. We aimed to describe the proportion of SAB cases with SEA and evaluate useful history or physical exam findings to help diagnose SEA.

Methods: This single-centre retrospective cohort study included consecutive SAB patients from 2021 to 2023. The index tests included risk factors, symptoms and signs of SEA as documented in patient charts. The reference standard was diagnosis of SEA based on spinal MRI or intra-operative finding during 90-day follow-up.

Results: Of 357 SAB patients, 29 (8.1%) patients had a SEA. Saddle anaesthesia, radicular pain, numbness or paresthaesia, and spine tenderness were most useful to rule in SEA based on positive likelihood ratio (PLR) of 22.6, 13.8, 9.9 and 7.5 respectively. Absence of acute back pain, no objective limb weakness, no subjective limb weakness and no spine tenderness were most useful to rule out SEA based on negative likelihood ratio (NLR) of 0.19, 0.46, 0.57, and 0.62 respectively. A clinical prediction rule based on these findings had a sensitivity of 97% (95% CI 83%-100%), specificity of 77% (95% CI 73%-82%), PLR of 4.3 (95% CI 3.5-5.3) and NLR of 0.05 (95% CI 0.01-0.31).

Conclusions: All SAB patients should undergo systematic neurologic evaluation for SEA as we found SEA is not an uncommon complication of SAB. A clinical prediction rule may be helpful to identify high-risk patients needing an urgent spinal MRI to assess for SEA.

Background: Despite recommendations by EU, surveillance of Lyme neuroborreliosis (LNB) is still not fully implemented in all member states, Sweden being one of them. Laboratory-based notifications on positive Borrelia antibody index (AI) in paired cerebrospinal fluid-serum samples alone have been suggested for surveillance of LNB.

Objectives: We aim to describe the epidemiology of Lyme borreliosis (LB) and LNB in Southern Sweden and assess if laboratory-based surveillance of LNB alone risks to underestimate the incidence in different populations.

Methods: Using register data, we categorized cases from Region Skåne County during 2009-2022 into four groups: A) cases with positive Borrelia AI, and data on ICD-10 codes given to them; B) cases with ICD-10 code indicating LNB but without positive Borrelia AI; C) cases with Lyme arthritis; and D) other disease manifestations of LB, mainly erythema migrans.

Results: Mean annual incidence for laboratory confirmed LNB (group A) was 3.2/100,000 inhabitants compared to 2.2/100,000 for cases with LNB diagnosis code but without positive Borrelia AI. Highest incidence in both these groups was noted among children 0-9 years old. Among cases in group B, 47% had a diagnosis code indicating facial nerve disorder, compared to19% in group A. For patients in group D, the mean annual incidence was 282/100,000 and increasing.

Conclusion: A considerable number of patients received a LNB diagnosis code without laboratory confirmation. Children and those with facial nerve disorder as LNB manifestation are at risk to be underreported if surveillance of LNB is based on positive Borrelia AI alone.

Background: Sepsis frequently occurs in hospitalised patients with cirrhosis. Among this cohort, meningoencephalitis is likely underdiagnosed, and Cryptococcus neoformans may be a common pathogen.

Objectives: Our study aims to (1) understand the epidemiology and mortality of meningoencephalitis in patients with cirrhosis, (2) identify those at risk for cryptococcal meningitis, and (3) assess the safety of lumbar puncture (LP).

Methods: The National Inpatient Sample was screened from 2016 to 2019 to identify hospital stays during which patients with cirrhosis underwent LP. We characterised the demographics, clinical data, and outcomes of those with and without meningoencephalitis. We then used logistic regression models to identify clinical factors associated with cryptococcal meningitis and described the incidence of LP-related complications.

Results: Among 3,435 hospitalisations, meningoencephalitis occurred in 274 (8%). Of all pathogens, Cryptococcus neoformans was the most common (19%) and most deadly (33% mortality; adjusted odds ratio [aOR] 2.31, 95% confidence interval [CI] 1.12-4.74; p = 0.02). Ascites was the only risk factor associated with cryptococcal meningitis (aOR 2.86, 95% CI 1.68-4.87; p < 0.001). LP-related complications were rare (<1%).

Conclusions: Cryptococcal meningitis is a common and morbid cause of meningoencephalitis among hospitalised patients with cirrhosis. LP is safe and should be considered in those with clinical features of infection without a clear source who fail to improve after standard therapy. However, the role of broader screening strategies among patients with cirrhosis remains uncertain, and further research is needed to refine diagnostic approaches for invasive fungal infections, including cryptococcal meningitis.

Background: While patients with post-COVID syndrome (PCS) suffer from cognitive deficits few studies directly compare patients with PCS to subjects recovered after an infection with the 'Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)'.

Objectives: To investigate cognitive performance adjusting for age, increasing body-mass-index (BMI), smoking, years of education, gender and hospitalisation while infected in patients with PCS compared to controls fully recovered. Secondly, to stratify cognitive performance based on the SARS-CoV-2 virus strain (variant of concern 'VOC') causing the infection. Thirdly, to assess whether patients with PCS have increased levels of psychological distress and affected hand grip strength as both are associated with cognitive performance.

Methods: A Danish-Swedish case-control study we recruited adult patients (18-75 years) with PCS from long-COVID outpatient clinics in Region Zealand Denmark and Skåne County Sweden. Participants had confirmed SARS-CoV-2 infection >12 weeks prior to inclusion and healthy control subjects had recovered completely. All study participants were exposed to cognitive tests, Kessler's psychological distress scale (K10) and tested with a hand-dynamometer.

Results: Recruiting 181 cases and 155 control subjects, patients with PCS had reduced cognitive performance scores on all domains though hardly clinically significant. Reduced processing speed was impacted the most with patients infected early in the pandemic exhibiting greater deficits.

Conclusion: PCS was associated with reduced cognitive processing speed compared to fully recovered controls with those infected early in the pandemic having greater deficits. Psychological distress and hand grip strength were affected in patients with PCS, but not decisively associated with cognitive performance.

Background: The surface antigen of hepatitis B virus (HBsAg) is present on viral particles (VP) and subviral particles (SVP) and is produced from both covalently closed circular DNA (cccDNA) and HBV DNA integrated into human chromosomes.

Objective: To calculate the contribution of VP and SVP to HBsAg levels in serum, and study to what extent the source of HBsAg is cccDNA or integrated HBV DNA.

Method: Analysis of HBV DNA and HBsAg levels from subjects with chronic HBV infection and after initiation or cessation of antiviral treatment.

Results: In serum samples from 800 individuals with chronic HBV infection and no antiviral treatment, the ratio between SVP and VP was > 100 million among HBe-antigen-negative subjects with low viral load. During initiation of nucleos(t)ide analogue (NA) treatment of 12 patients, the decline of HBsAg in serum was marginal or absent despite marked second phase reductions of HBV DNA, a proxy for cccDNA decline. After discontinuation of NA treatment, no increase in HBsAg levels was observed until HBV DNA had reached very high levels.

Conclusions: Viral particles do not significantly contribute to HBsAg levels in serum and in HBeAg-negative patients, and the VP/SVP ratio is much lower than previously described. The contribution from cccDNA to HBsAg levels seems to be significant only when the HBV DNA serum levels are very high and reflect a cccDNA content in the liver that produces HBsAg in amounts that equal or are greater than from integrated HBV DNA.