Infectious diseases (London, England)最新文献

Background: Plasma leakage is a key pathophysiological feature of severe dengue and typically precedes clinical deterioration. However, current diagnostic criteria rely on warning signs that often appear after leakage has begun.

Objectives: To identify early clinical and laboratory predictors of ultrasound-confirmed plasma leakage in adult dengue patients and evaluate their association with adverse clinical outcomes.

Methods: A retrospective cohort study of 507 adult patients with laboratory-confirmed dengue admitted to a tertiary Malaysian hospital between January 2022 and December 2023. Plasma leakage was defined by third-space fluid accumulation detected on point-of-care ultrasound. Multivariate logistic regression identified independent predictors from demographic, clinical, and laboratory variables measured at presentation.

Results: Ninety-nine patients (19.5%) developed plasma leakage. Independent predictors included older age (OR 1.042, 95% CI: 1.013-1.071), higher BMI (OR 1.615, 95% CI: 1.255-2.079), smoking (OR 2.955, 95% CI: 1.217-7.176), mucosal bleeding (OR 5.994, 95% CI: 1.152-31.185), elevated haematocrit (OR 1.613, 95% CI: 1.271-2.046), raised AST (OR 1.022, 95% CI: 1.011-1.033), low albumin (OR 0.850, 95% CI: 0.748-0.966), and elevated lactate (OR 29.668, 95% CI: 12.020-73.229). A lactate cut-off of ≥1.45 mmol/L yielded 96.0% sensitivity and 98.3% negative predictive value. These predictors were significantly associated with ICU admission, severe dengue, and prolonged hospital stay.

Conclusion: These findings support the use of objective, readily available markers to guide emergency department triage and decision-making where imaging is limited. The association between smoking and plasma leakage is a novel finding warranting further investigation.

Introduction: The recent outbreak of diphtheria in Nigeria affected mostly unvaccinated children; but a significant proportion of fully vaccinated children were affected prompting questions on level of immunity post vaccination.

Aim: To determine the seroprevalence of anti-diphtheria antibodies in children aged 6 months to 59 months.

Methods: In this cross-sectional analytic study conducted in Edo state, Nigeria, 257 apparently healthy children were studied. Following written informed consent, 3mls of blood was drawn. The blood was spun, separated and serum stored at -20 °C until analysis for anti-diphtheria antibodies by ELISA method. Anti-diphtheria IgG antibody levels were log-transformed and categorised as <0.01 IU/mL no protection, 0.01-0.09 IU/mL minimal protection, 0.1-0.9 IU/mL full protection and >1 IU/mL long term protection. Data analysis was done using SPSS with Statistical significance set at p < 0.05. Geometric mean titres (GMT) were calculated. Difference in mean titres was tested using student t test and ANOVA as appropriate.

Results: There were 158(61.5%) males and 99(38.5%) females. Overall GMT was 0.08 IU/mL. GMT of children younger than 12 months was 0.25 IU/mL and was higher than those of all other age groups p < 0.001. There were 54(21.0%) children with no immunity while only 10(3.89%) children had long term immunity. The age group 36-47 months had the highest proportion 14(51.4%) with inadequate immunity followed by the age group 48-59 months with 14(50%).

Conclusion: Significant proportions of Nigerian children have inadequate immunity despite having received 3 primary doses of diphtheria containing vaccine. We recommend booster doses in the second year of life.

Norovirus may cause chronic infection in immunocompromised patients. Both B-cell and T-cell responses are important for viral clearance. Currently, there is no established treatment but various substances have been evaluated, yielding mixedresults. This report presents a patient diagnosed with Good's syndrome, which includes hypogammaglobulinemia, who suffered from a chronic norovirus infection for several years. Nitazoxanide treatment was administered for 4 weeks due to ongoing diarrhoea and declining nutritional status; however, symptoms did not improve. Subsequently, fecal microbiota transplantation (FMT) was assessed using a single dose of cultured human microbiota. This procedure improved symptoms but did not eliminate the infection. The patient's symptoms returned after 6 months, at which time two FMT doses were administered, resulting in symptom amelioration. Three months later, a more pronounced relapse led to severe nutritional decline, most notably manifesting as overt vitamin A deficiency accompanied by visual impairment. Again, the patient underwent two administrations of FMT; however, relapse occurred shortly thereafter. Parenteral nutrition was then initiated after consultation with the hospital's clinical nutrition team. Symptoms promptly improved, with a decrease in diarrhoea and an increase in weight. A stool sample collected 2.5 months following the final FMT combined with parental nutrition demonstrated no detectable norovirus, and the patient has remained in stable health for 3 years. We believe that the patient's chronic norovirus infection was resolved through the combination of enhanced nutritional status and FMT.

Background: Herpes Zoster (HZ) is a common disease associated with morbidity, including cardiovascular complications, particularly in older adults and immunocompromised individuals.

Objective: To explore temporal changes in the incidence of hospital contacts due to HZ and estimate the risk of stroke and myocardial infarction (MI) following a hospital contact due to HZ.

Methods: This nationwide register-based cohort study from 1994 to 2022, included all adults (≥ 18 years) living in Denmark with a hospital contact due to a first-time event of HZ registered in the national patient register as an ICD-10 code. The incidences of hospital contact due to HZ were estimated by Poisson regression and reported per 100,000 person-years (PY). Furthermore, we estimated the hazard ratio (HR) of MI or stroke up to 90 days following a hospital contact with HZ using a Cox proportional hazard model.

Results: We included 23,433 individuals with a hospital contact due to HZ. The incidence of HZ increased in all age groups during the period, with the highest increase in the 60-64 age group from 10 (95% CI: 8-13) to 30 (95% CI: 26-33) per 100,000 PY. The HR of a stroke or MI after a hospital contact with an HZ diagnosis was 2.65 (95% CI: 2.06-3.42, p < 0.001).

Conclusion: We found that the incidence of hospital contacts with an HZ diagnosis increased during the past three decades. Also, the relative rate of cardiovascular events was higher after a hospital contact with an HZ diagnosis than in individuals without such an event.

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.