Infectious diseases (London, England)最新文献

Background: Long-term prospective data on antibody and T-cell responses beyond the third COVID-19 mRNA vaccine dose, particularly in relation to prior SARS-CoV-2 infections and breakthrough infections, remain limited.

Methods: Health care workers (HCWs) vaccinated with BNT162b2 were enrolled in January 2021. Blood samples were collected before and one month after each of four vaccine doses through December 2022. IgG antibodies against the spike receptor-binding domain (RBD) and the nucleocapsid (N) proteins were analysed, and T-cell responses (IFN-γ, IL-2, TNF-α) were measured after spike peptide stimulation. Neutralising antibodies (NAbs) against Omicron BA.1 were assessed in a subset (n = 61). RBD-IgG and cytokine levels were compared between infected and infection-naïve individuals, adjusted for age and sex.

Results: Among 108 HCWs, 32% were infected before vaccination. Breakthrough infections were rare before dose 3 but increased with the emergence of Omicron, affecting 77% of the participants until study end. RBD-IgG levels were consistently significantly higher in individuals with hybrid immunity than in infection-naïve participants, except one month after dose 3. When breakthrough infections were excluded, this difference only persisted through dose 3. IFN-γ responses largely mirrored RBD-IgG, while IL-2 responses were less affected by repeat doses and TNF-α responses were highly variable.

Conclusions: Individuals with hybrid immunity had significantly higher RBD-IgG levels than infection-naïve subjects up to 23 months post-vaccination when including breakthrough infections, while elevated antibody responses were limited to the first year in those infected pre-vaccination. Differences were more pronounced for antibody than T-cell responses when comparing individuals with and without breakthrough infections.

Objectives: RSV infections remain less well described than influenza infections. We compared symptoms, clinical characteristics and mortality in patients admitted with acute respiratory tract infections due to RSV and influenza virus.

Methods: We retrospectively collected data from the medical records of adult patients admitted to Akershus University Hospital with a positive PCR for RSV and influenza virus (H3N2, H1N1, and influenza B) from January 1, 2012 to December 31, 2021. We compared demographics, symptoms, and clinical characteristics, and assessed 30-day all-cause mortality using the Kaplan-Meier estimator and logistic regression.

Results: We included 2084 (72.7%) patients with influenza and 784 (27.3%) with RSV. RSV patients were older and more comorbid. Sputum production and dyspnoea were more frequently reported by RSV patients, whereas myalgia, headache, fever, sore throat, and gastrointestinal symptoms were more frequently reported by influenza patients. Fever on admission was more common in patients with influenza, whereas RSV patients more often presented with wheezing, higher white blood cell count, and more radiographic evidence of infection. RSV patients were more likely to require respiratory support, admission to higher levels of care, had longer hospital stays, and higher readmission rates. We observed no significant difference in 30-day mortality (adjusted odds ratio 0.93, 95% CI 0.64-1.33).

Conclusions: RSV and influenza are mostly clinically indistinguishable on admission, but fever is more frequent in influenza patients. RSV is associated with high utilisation of health care resources and a mortality risk comparable to influenza, highlighting the need for increased awareness and knowledge of RSV.

Objectives: To investigate the prevalence across age groups and age disparities in factors associated with pulmonary tuberculosis (PTB) in Indonesia through a large-scale sample study.

Methods: The data source was the National Basic Health Survey 2018. We recruited 715,394 individuals aged 16 years and older in this study. Rao-Scott Chi-square analyses and binary logistic regressions were employed to investigate the association of PTB with a significance threshold of 5%. Age-group disparities in factors significantly associated with PTB in all age groups were identified by interaction term analysis.

Results: In youth, middle-aged, and elderly groups, the prevalence of PTB was 3.5‰, 6.8‰, and 9.6‰, respectively. Logistic regressions with interaction term analysis found age differences in the association between PTB and former smokers (p for interaction = 0.022), diabetes (p for interaction = 0.0001), and heart disease (p for interaction = 0.005). Moreover, our findings showed age-related differences in the effect of sex, family size, and unemployment status on PTB. Males exhibited a greater PTB risk than females only among the middle-aged group (OR: 2.06; 95% CI: 1.48-2.86) and older adults (OR: 1.89; 95% CI: 1.38-2.62). Larger families (OR: 1.33; 95% CI: 1.12-1.59) and unemployed individuals (OR: 1.49; 95% CI: 1.21-1.83) were significantly associated with PTB only among middle-aged adults.

Conclusion: Comprehending age-specific factors for PTB is crucial for developing effective public health strategies. Early detection and advanced health education for PTB should be targeted at elderly men and middle-aged men who are jobless or have a large family.

Introduction: Congenital syphilis (CS) due to maternal transmission of Treponema pallidum is rising. The interpretation of conventional diagnostic methods is complicated by maternal antibody transfer. Polymerase Chain Reaction (PCR) syphilis testing has been widely studied in adults. PCR is reliable, fast, and can be performed on a variety of sample types.

Objectives: This systematic review aimed to evaluate existing data and summarise current international recommendations on the use of PCR testing on placental and neonatal samples for the diagnosis of CS.

Methods: A systematic search of PubMed, Ovid MEDLINE, and Cochrane databases was conducted, alongside an internet search of international congenital syphilis guidelines. The review was performed based on the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA statement. The review was registered on the International Prospective Register of Systematic Reviews (PROSPERO). Studies reporting PCR testing on placental or neonatal samples in infants born to mothers with syphilis were included. Guidelines with specific recommendations for congenital syphilis PCR testing were included.

Results: Of 221 studies screened, 21 were included, comprising 146 placental and 828 neonatal PCR samples. Only 4 multicentre studies were included. 8 studies included 5 or fewer PCR samples, including 5 single-patient case reports. Five international guidelines were included; all reserved PCR's application for high-risk infants with no clear guidance for low-risk infants.

Discussion: PCR shows promise as an adjunct diagnostic tool for congenital syphilis. However, evidence remains limited. Multicentre diagnostic accuracy studies are urgently needed to inform international recommendations and optimise diagnostic strategies.

Background: South Africa's antiretroviral therapy (ART) treatment guidelines in 2019 were revised to use dolutegravir as part of first-line ART instead of efavirenz due to recommendations from the World Health Organization and findings from clinical trials indicating noninferior efficacy and reduced side effects. Utilizing the target trial framework, we estimated the effect of initiating a dolutegravir-based regimen compared to an efavirenz-based regimen among treatment-naïve people living with HIV initiating treatment in Johannesburg, South Africa from 2019 to 2022 on retention and viral suppression.

Methods: We used linear regression to estimate causal risk differences on 12- and 24-month retention and viral suppression. Characteristics of those who initiated dolutegravir vs. efavirenz were balanced through inverse probability of treatment weighting. The covariates included: natal sex, age, year of initiation, education level, employment status, tuberculosis, WHO stage, smoking and alcohol use.

Results: Of the 2930 individuals initiating ART, 1847 initiated a dolutegravir-based regimen and 1083 initiated an efavirenz-based regimen. The median age was 45.1 years (IQR: 37.1, 53.0). Initiation of dolutegravir was associated with a 5-percentage point increase (95% confidence interval (CI): -0.02, 0.11) in retention and 4-percentage point increase (95% CI: -0.06, 0.16) in viral suppression at 12 months. At 24 months, dolutegravir was associated with a 10-percentage point (95% CI: 0.03, 0.16) increase in retention and a 14-percentage point (95% CI: -0.02, 0.30) increase in viral suppression.

Conclusions: Initiation of dolutegravir led to an appreciable increase in retention and viral suppression over 24 months when compared to efavirenz. Dolutegravir may lead to increases in long-term retention.

Background: Osteoarticular mycobacterial infections significantly impact patient health by causing severe joint and bone diseases. However, clinical experience in diagnosis and treatment remains limited.

Objectives: We investigated the clinical characteristics and prognosis of patients with osteoarticular mycobacterial infection.

Methods: We retrospectively enrolled 74 adult patients diagnosed with osteoarticular mycobacterial infection, including 57 (77%) with tuberculosis (TB) and 17 (23%) with non-tuberculous mycobacteria (NTM) infection, between January 2009 and January 2023 from a tertiary hospital in Korea. Osteoarticular mycobacterial infection was defined as the presence of osteoarticular infection, including prosthetic joint infection, diagnosed using clinical and radiological findings, and aspirate or tissue culture positive or polymerase chain reaction positive for Mycobacterium tuberculosis complex or NTM.

Results: Several differences were observed in the predisposing factors, affected sites and multifocal infections between the osteoarticular TB and NTM infection groups. The proportion of disseminated infection in patients with TB was higher than that in those with NTM infection (40% vs. 6%, p = .008). The positivity rate of acid-fast bacilli stain, mycobacterial culture, molecular testing and histological examination in all patients was 34%, 89%, 79% and 51%, respectively. Culture-positive or PCR-positive specimens from another site (respiratory specimens, pleural fluid, urine or blood) were collected from 22 patients (30%). Anti-mycobacterial therapy combined with surgical treatment was performed in 77% of all follow-up patients, and clinical failure occurred in 19%.

Conclusions: These findings suggest that, given the differences in optimal treatments, using multiple diagnostic modalities to detect microbiological evidence for discriminating NTM infection from TB is essential.

Background: Staphylococcus lugdunensis (SL) can cause infective endocarditis (IE), with unusually high complication and mortality rates. According to the 2023 Duke-ISCVID criteria, blood cultures positive for SL now count as a major microbiological criterion.

Objectives: Our aim was to determine the contemporary characteristics of SLIE, and to identify the factors associated with all-cause in-hospital mortality.

Methods: Patients with definite SLIE between 2010 and 2024 were included in a collaborative study involving 17 centres in France, Spain, Brazil, Italy, and Ireland.

Results: We collected data on 112 patients with definite SLIE. Mean age was 67 ± 18 years, and 76 (67.9%) were males. Nosocomial and healthcare-related non-nosocomial SLIE accounted for 15.2% and 16.1% of cases, respectively. Prosthetic valves and cardiac implantable electronic devices (CIED) were involved in 36.6% and 10.7% of cases, respectively. Emboli occurred in 50%, heart failure in 32%, acute kidney injury in 39.4%, and perivalvular abscesses in 20.5% of cases. All strains were methicillin susceptible. Valve surgery was performed in 47 (42%) and CIED removal in 10 (8.9%) patients. All-cause in-hospital mortality was 29.5%. Variables associated with mortality were age (OR 1.10 per one-year increment, 95%CI [1.08-1.31], p < 0.001), malignancy (OR 26.22, [3.78-181.72], p < 0.001), a new severe mitral regurgitation (OR 17.10, [2.81-104.09], p = 0.002), paravalvular abscess (OR 63.40, [6.24-644.03], p < 0.001), and new high-degree atrioventricular block (OR 27.76, [2.49-309.82], p = 0.007).

Conclusion: This international multicentre study confirms that SLIE mimics Staphylococcus aureus IE, particularly with regard to aggressiveness, healthcare-related acquisition, complications, and mortality. Of note, all SL isolates were methicillin-susceptible.