Infectious diseases (London, England)最新文献

Background: Although recommended isolation periods for Coronavirus disease 2019 (COVID-19) have been shortened as the pandemic has subsided, prolonged Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) shedding remains common in immunocompromised patients. This study estimated the probability of viral clearance in these patients based on elapsed days and specific risk factors.

Methods: We prospectively enrolled immunocompromised patients with a confirmed COVID-19 diagnosis from January 2022 to May 2023 during the Omicron variant era. We collected weekly respiratory specimens for viral load measurement and culture. We identified significant predictors of viral culture negative conversion through univariate and multivariate analyses and estimated viral clearance probabilities using a Cox time-varying proportional hazard model.

Results: Among 70 patients with serial 319 respiratory specimens with positive SARS-CoV-2 genomic polymerase chain reaction results that underwent cell culture, ∼69% (48) had haematologic malignancies and 31% (22) underwent solid organ transplants. B-cell depleting agents and viral copy number significantly influenced viral culture negative conversion. The probability of culture-negative conversion for immunocompromised patients not treated with B-cell-depleting agents increased over time, with over 90% achieving negative conversion by Day 84. Patients treated with B-cell depleting agents showed lower conversion rates. By Day 84, <90% of patients with cycle threshold values 23-28 [4.85-6.35 log copies/mL] achieved culture-negative conversion. The results indicate more prolonged shedding than in patients without B-cell depletion.

Conclusion: Estimating SARS-CoV-2 clearance probabilities based on specific risk factors can guide individualised isolation decisions for immunocompromised patients, tailoring policies to each patient's delayed viral clearance risk.

Crimean-Congo Hemorrhagic Fever (CCHF) presents significant global health challenges, highlighted by its sporadic nature and high fatality rates. The manuscript emphasizes the disease's tendency to be under-recognized and the diagnostic challenges it poses, often mimicking other illnesses and leading to frequent misdiagnosis. There is a noted absence of robust diagnostic tools, specific treatments, or vaccines, leaving only supportive care generally available. The necessity for increased international cooperation and a coordinated strategy to enhance disease surveillance, public health preparedness, and community education is stressed.

Background: Staphylococcus aureus bacteraemia (SAB) may lead to periprosthetic joint infections (PJI) via haematogenous spread of bacteria to the joint. Due to the risk of PJI, patients with SAB and prosthetic joint are recommended prolonged antibiotic treatment. The aim of the study was to assess the risk of PJI during SAB, and to evaluate if short treatment duration affects outcomes in patients with uncomplicated SAB and prosthetic joints without clinical signs of PJI.

Methods: Patients with growth of S. aureus in blood cultures were cross-referenced against the Swedish Arthroplasty register to identify patients with prosthetic hip or knee joints at the time of SAB. Medical records were reviewed to identify PJI at the time of SAB and during a 6-month follow-up period.

Results: Out of 400 patients with SAB and a prosthetic joint, 281 met all eligibility criteria and were included in the study. Of the included participants, 35 (12%) had a haematogenous PJI. Younger age and presence of multiple prosthetic joints were associated with an increased risk of PJI. Of the 247 patients without signs of PJI at the initial SAB episode, 118 patients (48%) had an uncomplicated infection and received short total antibiotic treatment (median 15 days, IQR 13-17). The risk of PJI during the follow-up period was low (<1%) and similar in the uncomplicated group compared to patients with complicated SAB that received longer antibiotic treatment (median 29 days, IQR 15-70).

Conclusion: The prevalence of haematogenous PJI was lower than previously reported. Our data do not support prolonged antibiotic treatment in patients with SAB and prosthetic joints without clinical signs of PJI.

Background: Combination therapy is an attractive therapeutic option for extensively drug-resistant (XDR) Pseudomonas aeruginosa infections. Existing data support the combination of aztreonam and ceftazidime/avibactam (CZA) against class serine-β-lactamase (SBL)- and metallo-β-lactamase (MBL) - producing Enterobacterales. However, data about that combination against SBL- and MBL-producing P. aeruginosa are scarce. The objective of the study was to assess the in vitro activity of CZA and aztreonam alone and in combination against SBL- and MBL-producing XDR P. aeruginosa isolates.

Methods: The combination was analyzed by means of the hollow-fiber infection model in three selected carbapenemase-producing P. aeruginosa isolates that were representative of the three most common XDRP. aeruginosa high-risk clones (ST175, ST111, ST235) responsible for global nosocomial infection outbreaks.

Results: The three isolates were nonsusceptible to CZA and nonsusceptible to aztreonam. In the dynamic hollow-fiber infection model, the combination of CZA plus aztreonam exerts a bactericidal effect on the isolates, regardless of their resistance mechanism and demonstrates synergistic interactions against three isolates, achieving a bacterial reduction of 5.07 log₁₀ CFU/ml, 5.2 log₁₀ CFU/ml and 4 log₁₀ CFU/ml, respectively.

Conclusion: The combination of CZA and aztreonam significantly enhanced the in vitro efficacy against XDR P. aeruginosa isolates compared to each monotherapy. This improvement suggests that the combination could serve as a feasible treatment alternative for infections caused by carbapenemase-producing XDR P. aeruginosa, especially in scenarios where no other treatment options are available.

Recent events, including a multi-state E. coli outbreak linked to McDonald's, have exposed significant vulnerabilities within fast-food supply chains. These incidents highlight complex issues of traceability and accountability, exacerbated by the high demands of fast-food operations which can compromise safety protocols. This paper discusses potential solutions such as advanced tracking technologies, uniform safety standards, and enhanced inspections to improve food safety. The focus is on strengthening public health protection and maintaining consumer trust in the fast-food industry.

Introduction: Pneumonia is one of the most common causes of hospital admissions in the United States and remains a major cause of death. However, less is known regarding the mortality burden from pneumonia in the United States and how this burden has changed over time.

Methods: Death rates from causes related to pneumonia were determined using the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) data from 1999-2019. Pneumonia deaths were calculated for the overall population as well as for sociodemographic subgroups. We also analysed changes in death rates over time.

Results: Overall, 2.1% of total US deaths during the period between 1999 and 2019 were due to pneumonia (2.6% in 1999 and 1.5% in 2019). Mortality declined over time for both men and women, and across most age cohorts, as well as all racial, urbanisation, and regional categories. Rates of pneumonia deaths were higher among males as compared to females (age-adjusted mortality rate ratio (AAMRR) = 1.35; 95% CI: 1.34-1.35). Compared to White Americans, Black Americans had the highest pneumonia-related mortality rates of any racial group (AAMRR = 1.11; 95% CI: 1.10-1.11).

Conclusions: Rates of pneumonia-related death have decreased in the United States in recent decades. However, significant racial and gender disparities remain, indicating the need for more equitable care.

The resurgence of polio in Pakistan, with 39 cases as of October 2024, threatens global eradication efforts. Despite progress, Pakistan remains one of two countries where poliovirus transmission persists, alongside Afghanistan. Key challenges include vaccine hesitancy, driven by misinformation and cultural misconceptions and ongoing violence against vaccination workers. While upcoming campaigns aim to vaccinate 45 million children, addressing these challenges requires more than immunisation drives. Strengthened community engagement, enhanced surveillance, and improved security for healthcare workers are critical. To meet the 2025 eradication goal, Pakistan must prioritise localised strategies to overcome barriers and ensure the sustainability of its eradication efforts.

Background: Interferons (IFNs) represent a first-line defense against viruses and other pathogens. It has been shown that an impaired and uncontrolled release of these glycoproteins can result in tissue damage and explain severe progression of coronavirus disease 2019 (COVID-19). However, their potential role in Long-COVID syndrome (LC) remains debateable.

Objectives: The objective of the present study is to shed further light on the possible role of IFNs (and related genes) gene expression patterns in the progression of COVID-19 and LC patients.

Methods: We carried out a multi-cohort study by analyzing the IFN gene expression patterns (using different IFN gene signatures) in five cohorts of acute COVID-19 (n = 541 samples) and LC patients (n = 188), and compared them to patterns observed in three autoimmune diseases (systemic lupus erythematous [n = 242], systemic sclerosis [n = 91], and Sjögren's syndrome [n = 282]).

Results: The data show that, while the interferon signatures are strongly upregulated in severe COVID-19 patients and autoimmune diseases, it decays with the time from symptoms onset and in LC patients. Differential pathway analysis of IFN-related terms indicates an over activation in autoimmune diseases (IFN-I/II) and severe COVID-19 (IFN-I/II/III), while these pathways are mostly inactivated or downregulated in LC (IFN-I/III). By analyzing six proteomic LC datasets, we did not find evidence of a role of IFNs in this condition.

Conclusion: Our findings suggest a potential role of cytokine exhaustion mediated by IFN gene expression inactivation as a possible driver of LC.