Infectious diseases (London, England)最新文献

Background: Invasive pneumococcal disease (IPD) remains a significant public health concern, particularly in vulnerable populations such as the elderly. This study focuses on the Faroe Islands, a unique setting for monitoring pneumococcal disease trends due to its high vaccination coverage and geographic isolation.

Objective: To examine the prevalence, trends and serotype distribution of IPD in the Faroe Islands from 2000 to 2023, focusing on the impact of pneumococcal conjugate vaccines (PCVs) on disease incidence and serotype replacement.

Methods: Eighty-six pneumococcal isolates, representing all registered cases of IPD in the Faroe Islands, were analysed during the study period. Data on patient demographics, serotype identification and vaccination history were collected from national health records. Temporal trends in vaccine-type (VT) and non-vaccine-type (nVT) serotypes were analysed, particularly following the introduction of PCV13 in 2010.

Results: Following the introduction of PCV13, a shift from VT to nVT serotypes was observed, while the overall IPD rate remained stable. Notably, there was an increase in IPD cases among the elderly population. The analysis indicated that serotype replacement contributed to a rise in nVT cases despite reducing VT-related IPD.

Conclusions: The findings emphasise the need for ongoing evaluation of pneumococcal vaccine formulations and alternative strategies to address the increasing prevalence of nVT IPD. Higher-valency vaccines and sustained vaccination coverage are critical to mitigating the impact of serotype replacement and improving public health outcomes in the Faroe Islands.

Background: Environmental contamination with Opisthorchis viverrini eggs significantly impacts on opisthorchiasis transmission and disease control. This study assessed O. viverrini egg contamination in underwater sediments from canals and aimed to reduce O. viverrini transmission in egg-positive and downstream communities by controlling human opisthorchiasis in endemic area of Northeast Thailand.

Methods: Sediment samples from 14 sites in UdonThani municipality were determined for O. viverrini eggs. Human fecal samples and fish were examined for opisthorchiasis and metacercaria infection, respectively. Water samples were analysed for faecal coliforms bacteria. From 2017 to 2023, transmission control efforts were evaluated by monitoring changes in human and fish infection rates.

Results: In 2017 and 2018, O. viverrini eggs were found in canal sediments at 153 and 86 eggs/liter, respectively. Human opisthorchiasis prevalence was 5.3%, with cyprinoid fish showing a 25.0% infection rate (11.6 cysts/infected fish) and significant fecal contamination (>5,500 CFU/100 ml). Conversely, egg-negative sites showed a 0.5% human infection rate and no metacercariae were found. After health interventions (2019 to 2023), O. viverrini eggs were not detected in sediments from canals, resulting in a significant reduction in human opisthorchiasis prevalence to 0.9% at the previously egg-positive site and from 12.2% to 1.7% in downstream communities (p < 0.001). Additionally, the prevalence of metacercariae in cyprinoid fish decreased from 11.4% (7.6 cysts/infected fish) to 4.5% (2.4 cysts/infected fish), indicating reduced transmission.

Conclusion: The presence of O. viverrini eggs in sediment was associated to human opisthorchiasis transmission and demonstrated the significant effectiveness of health interventions in controlling the disease.

Hepatitis delta virus (HDV) infection has an aggressive disease course and is the most difficult to treat of the human hepatitis viruses. In Denmark, as in many countries, the national prevalence of HDV has not been established. Based on diagnoses and laboratory test results in national healthcare registries, we estimated that the prevalence of current HDV infection amongst patients with chronic hepatitis B was 3.1% and the general population prevalence approximately 4 in 100,000.

The pertussis epidemic in Korea is ongoing, with a record-high incidence rate. Although pertussis incidence is high worldwide in 2024, the scale of the increase observed in Korea is unprecedented and incomparable to that in other countries. The high proportion of cases among children aged 5 to 14 years is the distinctive characteristics of the 2024 pertussis epidemic in Korea. To accurately interpret the epidemiological trend in pertussis incidence in Korea, validating the surveillance system and evaluating vaccine efficacy and effectiveness are essential.

Background: Vertebral osteomyelitis (VO) is an infection of the spine with increasing prevalence due to improved diagnostics and aging populations. Multiple pathogens, including Mycobacterium tuberculosis, Brucella spp., and pyogenic bacteria, can cause VO, making differential diagnosis complex, especially in regions with endemic brucellosis and tuberculosis. Early and accurate diagnosis is essential for appropriate treatment.

Methods: This was a single-center, retrospective, observational study performed between 2019 and 2022 in Kashi, Xinjiang.

Results: In this study, a total of 319 patients were enrolled, comprising 45.5% with tuberculous vertebral osteomyelitis (TVO; 52.4% females), 37.9% with brucellar vertebral osteomyelitis (BVO; 19.8% females), and 16.6% with pyogenic vertebral osteomyelitis (PVO; 52.8% females). Demographically, TVO had a longer mean time to diagnosis compared to BVO and PVO. BVO was more prevalent in male, and PVO patients had higher rates of spinal surgery history (45.3%) and diabetes (13.2%). Clinically, TVO patients presented with fever (72.4%), sweating (83.4%), weight loss (71.7%), and appetite loss (84.8%) more frequently, while BVO patients reported more lower back pain (86.0%). Laboratory investigations revealed significantly higher leucocyte and neutrophil levels in PVO, whereas TVO patients had elevated monocyte-to-lymphocyte and platelet-to-lymphocyte ratios. Radiologically, TVO patients exhibited a higher incidence of thoracic involvement (56.6%) and skip lesions (20%). Microbiologically, BVO and PVO had high positive culture rates (84.3 and 84.9%, respectively), with M. tuberculosis isolated from only 4.1% of TVO patients.

Conclusion: These findings underscore the distinct clinical, laboratory, and radiological characteristics of TVO, BVO, and PVO.

Background: Climate change significantly influences the distribution and severity of tropical diseases. Rising temperatures, changing precipitation patterns, and extreme weather events are transforming the habitats of vectors like mosquitoes and ticks, promoting their proliferation and geographic spread. These changes have facilitated the resurgence of diseases such as malaria, dengue, and chikungunya fever in previously unaffected areas, including parts of Europe and Italy.

Objective and methods: This review aims to explore the relationship between climate change and the spread of vector-borne and tropical parasitic diseases across Europe, with a particular focus on Italy. Recent studies are analyzed to identify emerging trends in disease transmission influenced by shifting climates. Genome-based monitoring and predictive models incorporating climatic and ecological data are highlighted as methods to enhance disease surveillance and preparedness.

Results: The analysis reveals a clear link between climate change and altered disease patterns. The proliferation of vectors into new territories is associated with increased incidence of diseases. Genome-based tools demonstrate their utility in tracking the evolution of pathogens, particularly regarding changes in virulence, drug resistance, and adaptability to new climates. Predictive models have proven effective in anticipating outbreaks and supporting timely public health interventions.

Conclusions: To mitigate the risks posed by climate-induced changes in disease dynamics, continuous monitoring and international collaboration are essential. Strengthening health systems' resilience through mitigation and adaptation strategies is crucial for preventing future epidemics. These insights contribute to the development of sustainable long-term policies for managing tropical diseases in the context of climate change, ensuring timely responses to public health emergencies.

Objective: Bloodstream infections (BSIs) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) are a serious threat to public health. In this study, it was aimed to evaluate the risk factors, treatment, length of hospitalisation and mortality of patients with BSI caused by CRKP.

Methods: Between October 2021 and October 2023, patients aged 18 years and older who were treated for BSI at Mersin University Faculty of Medicine Hospital and had pathogens identified as CRKP or carbapenem-sensitive Klebsiella pneumoniae (CSKP) were retrospectively reviewed and included in the study.

Results: Of the 107 patients with BSI included in the study, 66 (61.7%) had CRKP and 41 (38.3%) had CSKP. The risk factors associated with CRKP in BSIs were found to be acute renal failure (p = 0.048), mechanical ventilation (MV) (p = 0.042), post-earthquake period (p = 0.022) and use of carbapenem (p < 0.0005) and other beta-lactam antibiotics (p = 0.039). Mortality was significantly higher in BSIs caused by CRKP (80.3%/29.3%, p < 0.0005). In the CRKP group, intensive care unit follow-up (p = 0.020), intubation (p = 0.039), MV monitoring (p = 0.025) and concomitant pneumonia (p = 0.043) significantly increased mortality. There were no significant differences in treatment outcomes between ceftazidime-avibactam and carbapenem combinations (p > 0.05). In the CRKP group, the duration of treatment and hospital stay were significantly longer in patients who started treatment three days or later (p = 0.036/p = 0.011).

Conclusion: This study demonstrates that identifying risk factors for BSIs caused by CRKP and implementing early treatment protocols may lead to a reduction in treatment time and mortality rate.

Background: The overuse of antibiotics may lead to complications such as increased resistance, adverse events, and toxicities. Literature demonstrates a negative Methicillin-resistant Staphylococcus aureus (MRSA) nares polymerase chain reaction (PCR) may be used to streamline antibiotic therapy prior to respiratory culture results based on a negative predictive value (NPV) of 95-99%. Additional literature supports a high NPV when MRSA nares PCR is evaluated in non-respiratory cultures; however, this use in critically ill patients has not been studied.

Objectives: The purpose of this study was to evaluate the clinical utility of MRSA nares PCR in non-respiratory cultures in critically ill patients.

Methods: This was a single centre, retrospective, cohort evaluation. Outcomes evaluated were NPV, positive predictive value (PPV), sensitivity, and specificity of MRSA nares PCR in critically ill patients. A sub-group analysis based on the site of culture (blood, urine, and wound) was also conducted.

Results: Of the 325 patients screened, 200 critically ill patients were included for analysis. A total of 259 cultures were evaluated with blood being the most common source (n = 124). The MRSA nares PCR was positive in 34 (17%) patients and thirteen (5%) of the 259 cultures were positive for MRSA. For all cultures, the MRSA nares PCR demonstrated an NPV 99%, PPV 28%, sensitivity 77%, and specificity 85%. The subgroup analysis for the individual culture types reflected similar findings.

Conclusions: A negative MRSA nares PCR may be used to withhold initiation or allow for timely de-escalation of anti-MRSA antibiotics in critically ill patients if clinically applicable.

Purpose: A post hoc analysis of data from a previously published clinical trial was conducted using the desirability of outcome ranking (DOOR) methodology with the aim provide additional information on the use of fosfomycin for the treatment of bacteraemic urinary tract infection (BUTI) caused by multi-drug-resistant (MDR) E. coli.

Methods: Three DOOR systems with five, six and seven categories, respectively were developed. Safety and efficacy were prioritised in all rankings, but step down to oral therapy and exposure to antibiotics with lower ecological impact were also considered in DOOR-6 and DOOR-7. The probability that a patients assigned to fosfomycin was classified into a more desirable outcome category was calculated for the three DOOR definitions. Subgroups analyses and an ordinal logistic regression model were also performed.

Results: Data from 143 participants were analysed. The probability of having a more desirable outcome after treatment with fosfomycin versus the comparators was 0.44 (95% CI 0.36 - 0.52) for DOOR-5; 0.50 (95% IC 0.42 - 0.58) using DOOR-6 and 0.61 (95% CI 0.53-0.69) with DOOR-7. In subgroups, the highest probability of having a better DOOR with fosfomycin was seen in the clinically evaluable population and among patients without chronic heart disease or renal insufficiency for the DOOR-7 definition.

Conclusions: DOOR analysis could be applied to the FOREST trial data; the results were somehow different for the different DOOR systems used. Overall, fosfomycin was favoured when oral step-down treatment and use of antibiotics with lower ecological impact were included.

Background: Comorbidities complicate the management of tuberculosis (TB) and have become an essential part of the end TB strategy to eradicate TB. However, pulmonary TB has received the most attention, and little is known about the impact of comorbidities and other factors on outcomes in patients with extrapulmonary tuberculosis (EPTB).

Objectives: Our aim was to analyze the factors associated with hospitalization and mortality in EPTB at a hospital in Central India, using non-TB patients with similar clinical presentations as a comparison.

Methods: Patients with presumptive EPTB were prospectively enrolled and followed up until the end of treatment or for at least 6 months. Detailed demographic and clinical information was collected for all participants, and patients were categorized as TB or non-TB using a composite reference standard. Multivariate logistic regression was used to analyze the impact of various clinical findings and risk factors on hospitalization and mortality.

Results: A total of 276 patients were categorized as TB cases and 175 as non-TB cases. Factors associated with hospitalization in children were younger age and non-adenitis site of disease. In adults, factors associated with mortality were older age, non-adenitis site of disease and HIV infection regardless of TB diagnosis, while diabetes mellitus increased the odds of mortality in EPTB patients.

Conclusion: Our results show that comorbidities increase the odds of death in both TB and non-TB patients in low-resource settings. This argues for a shift away from the traditional vertical management of diseases in these areas and supports a continued focus on building robust healthcare systems.