Infectious diseases (London, England)最新文献

Background: Cases of invasive group A streptococcal infections (iGAS) increased dramatically in Sweden and other high-income countries during 2023 and 2024. Changing epidemiology and stricter antibiotic stewardship policies are suggested to contribute to this increase.

Objectives: To describe the clinical presentation and previous health care contacts among cases of iGAS infection over a 5-year period.

Methods: A retrospective cohort study of iGAS patients treated at Sahlgrenska University Hospital, Gothenburg, Sweden, between January 2020 and July 2024, identified through the hospital's Clinical Microbiology Laboratory Information System. Data was collected through detailed medical record review by the study team.

Results: In total, 190 patients with iGAS were included, with the majority (70%, n = 133) treated during 2023-2024. The median age was 53 years (range 1-97) and 51% had no chronic comorbidities. The most common clinical manifestations were erysipelas (22%, n = 42), bacteraemia without focus (21%, n = 39), lower respiratory tract infection (15%, n = 29) and necrotising soft tissue infection (13%, n = 25). Thirty-day mortality was 13% (25/190) with the highest mortality risk for patients with bacteraemia without focus. Relevant health care contacts within 30 days before hospitalisation could be analysed in 167 patientsand was documented in 27% (n = 45) of these cases, most commonly due to a wound (10%, n = 17) or sore throat (9%, n = 15).

Conclusion: The post-pandemic increase in iGAS affected all age groups. Soft tissue infections remained the dominant type of infection, with erysipelas accounting for around one in four episodes. The iGAS patients had frequently sought care with related complaints shortly before hospitalisation.

Background: Iran has been recognised as a polio-free country since 2006; however, it remains vulnerable to new cases of polio. Moreover, the risk of transmission is high due to neighbouring endemic countries, illegal refugees, and immigrants.

Objectives: This study aims to update the epidemiological profile of acute flaccid paralysis (AFP) and vaccine-associated paralytic polio (VAPP) among children <15 in Iran from 2014 to 2023, and to assess the performance of the national AFP surveillance system.

Methods: This study was conducted as a retrospective descriptive analysis of AFP surveillance data among children <15 from 2014 to 2023. The source of data was the National Notifiable Disease Surveillance System in Iran. Surveillance performance indicators were assessed according to World Health Organisation (WHO) standards.

Results: The AFP cases were 8,368 during the study period. The rate of non-polio AFP increased from 4.19 per 100,000 in 2014 to 5.49 in 2023, and Stool adequacy remained above 80% throughout the study period. Nineteen suspected VAPP cases were identified, all of which were investigated according to WHO criteria and confirmed as non-polio causes. All the performance indicators of the National Notifiable Disease Surveillance System were within acceptable ranges with WHO targets. No cases of wild poliovirus have been reported in Iran since 2000.

Conclusion: Iran's AFP surveillance system is robust and sensitive, playing a vital role in maintaining the country's polio-free status. Given Iran's shared border with endemic countries and the risk of introduction of wild or vaccine-derived polioviruses, continuous and enhanced surveillance is essential.

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: Rapid blood culture diagnostics enable early targeted antimicrobial therapy, but microbiology laboratories rarely process signal-positive blood cultures 24/7. Our HUS Diagnostic Center Bacteriology laboratory started processing signal-positive blood cultures 24/7 in February 2021 and in February 2022 we implemented a molecular rapid diagnostic test (mRDT) into our workflow.

Objectives: We aim to show how these changes impacted blood culture turn-around-times (TAT) and patient care in the capital region of Finland.

Methods: We performed a retrospective cohort study of adult patients with positive blood cultures treated in HUS healthcare units from January 2019 to December 2023. We identified eligible patients from our laboratory information systems, and our final cohort included 15311 patients divided into three groups: pre-intervention group (January 2019-January 2021), 24/7 group (February 2021-January 2022), mRDT group (February 2022-December 2023). We compared the groups in terms of diagnostic TATs, and treatment outcomes.

Results: The median TAT for microbial identification decreased from initial 39h to 19h (p < 0.001), and for antimicrobial susceptibility testing result from 45h to 36h (p < 0.001). For resistant phenotype isolates the median time to effective antimicrobial therapy decreased from 34h to 21h (p < 0.001). Median time to optimal antimicrobial therapy for Staphylococcus aureus decreased from 45h to 28h (p < 0.001).

Conclusion: Combining 24/7 workflow with a mRDT provides substantial reductions in blood culture TATs. However, a minority of patients benefited from the rapid diagnostics in terms of effective therapy initiation, and early antimicrobial therapy optimization requires active antimicrobial stewardship.

Purpose: The northern part of India is hyperendemic for acute encephalitis syndrome (AES) among children. In a significant proportion of AES cases, the causative agent remained unknown. We prospectively investigated the etiologies in pediatric AES (pAES) cases.

Methods: The pAES cases hospitalized at the tertiary care center from January 2022 to December 2023 were recruited in this study. Serological and molecular investigation was done, using available cerebrospinal fluid/whole blood/serum samples. Sequencing was done for positive samples.

Results: A total of 557 confirmed AES cases were recruited for the study. A comprehensive investigation for infectious cause identified etiologies in 76.1% (424/557) of pAES cases. In non-JE associated AES, viral infections such as cytomegalovirus (CMV) and herpes simplex virus (HSV-1), along with bacterial infections caused by Orientia tsutsugamushi (OT), Rickettsia, and Leptospira, have emerged as the leading causes in the studied region. About 9.7% (45/463) of cases were fatal. Among fatalities, 62.2% were females; 28.9% were positive for OT, 6.8% for JE, and 2.3% for Leptospira. Either mixed viral or viral-bacterial infections were observed in 13.6% of fatalities. No identifiable causative agent was detected in 48.9% (22/45) of cases. The greatest number of deaths occurred in the post-monsoon season.

Conclusion: This research highlights a notable change in the profile of pathogens associated with pAES. Further, findings also suggest that the use of more comprehensive PCR panels can provide in-depth identification of etiologies associated with pAES. Finally, these findings could guide policymakers in updating diagnostic and treatment protocols for better management of pAES cases in India.

Background: HIV-positive organ transplant recipients are at high risk of anal cancer, but there are no data on the prevalence of high-risk human papillomavirus (hr-HPV) or anal dysplasia, in this population.

Objective: To assess the prevalence of anal hr-HPV, and anal cytological and histological abnormalities in this population.

Design and setting: Prospective single tertiary hospital.

Results: Twenty-five (53%) transplant recipients were recruited from 47 eligible individuals. Median (IQR) age was 56 years (52.5-60), 17 were male, 9 (36%) were men who have sex with men and 8 (32%) were active smokers. Twelve (48%) patients had abnormal anal cytology and 12 (48%) had detectable hr-HPV DNA. Six (50%) individuals with abnormal cytology had high-grade squamous intraepithelial lesions (HSIL) on biopsy. Abnormal anal cytology was significantly associated with current hr-HPV infection [crude prevalence rate ratio, cRR = 2.3, 95% CI (1.43-3.7); p = 0.001] and any previous history of HPV associated disease [cRR = 2.49, 95% CI (1.09-5.67); p = 0.030]. Anal HSIL on biopsy was associated with presence of condyloma [cRR = 3.00, 95% CI (1.31-6.88); p = 0.001] and any previous history of any HPV associated disease [cRR = 6.67, 95% CI (0.96-46.32); p = 0.055]. Anal hr-HPV infection was associated with any previous HPV disease (Crude risk ratios [cRR = 2.89, 95% CI (1.21-6.88); p = 0.017]) and presence of condyloma (Crude risk ratios [cRR = 2.00, 95% CI (1.28-3.13); p = 0.002]). No cases of invasive anal cancer were detected among study participants.

Conclusions: This highly medicalized population of HIV-positive organ transplant recipients have a high prevalence of HPV-associated anal dysplasia and screening to prevent anal cancer may need to be prioritised.

Background: Antibiotic-induced perturbations of the gut microbiome impair immunologic responses but whether they influence disease severity is unknown. The COVID-19 pandemic provided a unique opportunity to explore this question given widespread testing for SARS-CoV-2 infections.

Objective: To determine whether prior antibiotic exposure was associated with outcomes in patients with COVID-19.

Methods: Retrospective cohort study of all community-dwelling adults in Alberta, Canada with COVID-19 between March 2020 and June 2023. Subjects with antibiotic dispensations in the prior 3 months were compared (using multivariable logistic regression and propensity score (PS)-matching) to those without antibiotic exposure for differences in 30-day outcomes.

Results: Of 445,646 adults with COVID-19, 49,581 (11.1%) were exposed to at least one antibiotic course in the prior 3 months. Those exposed to antibiotics were more likely to present to an emergency department (13.4% vs. 7.4%, aOR 1.52, 95%CI 1.48-1.57, PS-matched OR 1.48, 1.42-1.54), be hospitalised (5.8% vs. 2.8%, aOR 1.40,1.33-1.46, PS-matched OR 1.37, 1.29-1.45), or die (1.7% vs. 0.6%, aOR 1.28, 1.18-1.40, PS-matched OR 1.27, 1.14-1.42) than patients without prior antibiotic exposure. The associations were similar whether the antibiotic prescriptions were appropriate or not or whether antibiotic exposure periods were 6 weeks, 6 months, or 12 months prior to the positive RT-PCR test. The associations were stronger in those individuals with the highest tertile of antibiotic exposure, or those exposed to broad-spectrum antibiotics, or younger patients.

Conclusion: Prior antibiotic exposure is associated with worsened disease severity in patients infected with SARS-CoV-2. These findings support efforts to reduce antibiotic use.

Background: Dengue infection is a major public health threat, especially to children.

Objectives: To comprehensively summarise the global epidemiological evidence on dengue in paediatric and adolescent populations by reporting incidence proportions, seroprevalence by region, country, and age group, and presenting pooled odds ratio (OR) estimates between age, sex, and infection risk.

Methods: MEDLINE and Embase were searched until April 2024. This meta-analysis included studies reporting or allowing calculation of incidence proportion, seroprevalence, and ORs; pooled estimates were derived using random-effects models.

Results: One-hundred fifty-eight articles were included. Incidence proportions were similar across the Americas, Africa, and Asia; country-specific incidence proportion was highest for Yemen (65%) and Brazil (53%). Seroprevalence was highest in Oceania and the Americas; country-specific seroprevalence was highest in Nicaragua (91%), and Honduras (88%). ORs of dengue infection did not differ between males and females [1.04 (95%CI: 0.95-1.14), p = 0.36]. However, dengue infection increased by age group with OR of 1.84 (95%CI: 1.51-2.24), p < 0.001 for children <10-years and 2.53 (95%CI: 2.03-3.16), p < 0.001 for those aged ≥10-years. The World Health Organisation's 2018 and 2024 position statements recommend CYD-TDV vaccination in countries where the seroprevalence reaches ≥80% and TAK-003 where it is ≥60% by nine years of age. However, our data indicate that no country meets the 80% threshold, and very few reach 60% seroprevalence by age 10.

Conclusion: Dengue infection affects youth globally across all endemic regions, with similar incidence distribution among continents. These findings illuminate the global and country-specific dengue epidemiology, emphasising the need for enhanced mitigation measures to reduce viral spread and impact.

Introduction: The development of predictive mortality scores for bacteraemia is fundamental for identifying patients in whom increasing our management efforts. However, it is necessary to assess the validity of the results obtained when they are applied to new cohorts.

Methods: We evaluated the ability of different scales (Charlson, also age-adjusted Charlson and updated Charlson, SOFA, Pitt, INCREMENT-ESBL and BSIMRS) to predict 30-day mortality in bacteraemia through the AUROC and calibration plots. The scales were applied to specific patient from PROBAC cohort (prospective, multicentre with bacteraemia of any aetiology) according to the population in which the scale was originally developed. We also applied the recently developed PROBAC score (this time applied to the entire PROBAC cohort, rather than only to patients who did not die within 48 h of blood culture collection as in the original development of the scale).

Results: After applying Charlson, age-adjusted Charlson, updated Charlson, SOFA, Pitt and PROBAC to the entire PROBAC cohort, we obtained AUROC values: 0.60 (95% CI: 0.58-0.62); 0.62 (95% CI: 0.60-0.64); 0.60 (95% CI: 0.58-0.62); 0.69 (95% CI: 0.66-0.71); 0.71 (95% CI: 0.69-0.82) and 0.80 (95% CI: 0.79-0.81), respectively. INCREMENT-ESBL was applied only to gram negative bacteraemia yielding 0.81 (95% CI: 0.79-0.82) and BSIMRS to gram negative bacteraemia who received adequate empirical antibiotic yielding 0.72 (95% CI: 0.70-0.75).

Conclusions: Scores that have been developed in bacteraemia cohorts and have been used for the prediction of short-term mortality were found to be better at predicting mortality in our analysis.

Background: Dengue fever (DF) a significant public health challenge globally, with clinical manifestations ranging from mild symptoms to severe dengue.

Objectives: To identify the clinico-epidemiological characteristics, management, and outcomes of severe dengue fever among inpatients of a tertiary care hospital.

Settings and design: Prospective observational study was conducted in a tertiary care hospital, Karnataka.

Materials and methods: Study included all laboratory-confirmed adult dengue patients admitted to Departments of General Medicine and Infectious Diseases during the study period. Socio-demographic, clinical, and laboratory data were collected and analysed.

Statistical analysis used: Descriptive and analytical tests, including multiple logistic regression analyses, were performed.

Results: Among 443 patients, 70% were males. Fever (91.9%) and aches/pains (81.7%) were most frequently reported symptoms with thrombocytopenia (81.9%), elevated AST (81.2%), and ALT (73.3%) were commonly observed. Severe dengue was observed in 12.1% of patients, frequently accompanied by acute kidney injury (32.9%), hepatitis (29.4%), and multiple organ dysfunction (22.4%). Severe cases were associated with age over 60 (COR = 4.6; 95% CI:2.1-9.9), low education status (COR = 3.6; 95% CI:1.3-10.4), unskilled occupations (COR = 4.2; 95% CI:1.1-15.8), presence of co-morbidities (COR = 2.5; 95% CI:1.4-4.4) and co-infections (COR = 5.2;95% CI:2.7-9.8), and supportive treatment (COR = 3.9; 95% CI:2.1-7). Independent predictor for severity was coinfection (AOR = 15.6; 95% CI:3.9-61.7). Supportive care was received by 36.3% patients, with 97.5% showing improvement, while 1.6% succumbed to death.

Conclusion: The study highlights the significant burden of severe dengue, stressing the importance of early detection, supportive care, and treatment of co-infections.