Infectious diseases (London, England)最新文献

Introduction: Strategies for tuberculosis (TB) elimination in low-incidence countries involve screening recent migrants from TB-endemic regions for TB infection (TBI) and providing TB preventive treatment (TPT) to individuals with an increased risk of reactivation. This study aimed to determine TB incidence and identify reactivation risk markers in a cohort of asylum seekers in Sweden after screening.

Method: We conducted a registry-based retrospective cohort study with a three-year follow-up of asylum seekers receiving post-arrival Interferon Gamma Release Assay (IGRA) screening in three Swedish regions 2015-2019. Medical records, health-examination records, and the national TB disease registry were linked using identification numbers or probabilistic methods. The primary outcome was TB disease more than 90 days post-screening. Explanatory variables included age, sex, IGRA-result (positive/negative), TPT-initiation, and TB incidence in the country of origin. Poisson and Cox regression addressed incidence rates (IR), incidence rate ratios (IRR), and hazard ratios over a three-year follow-up.

Results: The cohort included 21 739 individuals and 70 467 person-years. Incident TB disease was recorded in 41 cases (IR 58.2/100 000 person-years). The IR for those with a positive IGRA was 321.7/100 000 person-years (n = 34). The highest risk was in persons aged under 20 with no TPT (1 279.0/100 000 person-years). Positive IGRA result, age under 20 years, and origin from TB-endemic country predicted incident TB.

Discussion: Risk markers for incident TB were similar to findings previously reported. However, the observed 0.3% annual reactivation risk found among all IGRA-positive individuals in this study was considerably lower compared to earlier findings.

Background: Hepatitis is a variably reported manifestation of acute Q fever; however, its clinical implications remain unclear. This study investigates whether hepatitis is associated with distinct clinical features and outcomes compared to cases without hepatitis.

Methods: Data from a retrospective, single-centre study of adult patients diagnosed with acute Q fever between January 2018 and December 2023 were analysed. Patients with clinical and laboratory evidence of acute infection, defined by positive phase II IgG serology or Coxiella burnetii RT-PCR were included. Patients were categorised into two groups based on the presence or absence of hepatitis, defined as elevated liver transaminases above the upper normal limit. Descriptive comparisons were conducted between the two groups.

Results: 116 patients were included, 87 in the hepatitis group and 29 in the non-hepatitis group. The hepatitis group showed a male predominance (66.7%), while the non-hepatitis group had a higher proportion of females (55.2%) (p = 0.03). Fever was more common in the hepatitis group (85.1%) compared to the non-hepatitis group (65.5%) (p = 0.02). A confirmed diagnosis was more frequent in the hepatitis group (62.1% vs. 27.6%) (p < 0.001). A greater proportion of patients in the hepatitis group received appropriate antibiotic treatment (79.3% vs. 44.8%), with earlier initiation. Despite these differences, complication rates were comparable between groups, and no in-hospital mortality was observed.

Conclusion: Hepatitis is a common manifestation of acute Q fever and is associated with a higher likelihood of confirmed diagnosis and earlier initiation of appropriate antibiotic treatment. Clinical outcomes remain favourable, even in patients with hepatitis.

Background: Dalbavancin is a long-acting lipoglycopeptide approved for acute bacterial skin and soft-tissue infections. Its prolonged half-life enables outpatient treatment, reducing the burden of hospitalisation. Despite increasing off-label use for complex Gram-positive infections, real-world effectiveness data remain limited.

Objective: This study aimed to evaluate the clinical effectiveness and safety of dalbavancin in a real-world tertiary care setting in Sweden.

Methods: We retrospectively analysed the medical records of all patients (n = 66) who received dalbavancin in Region Västmanland, Sweden, from 2019 to 2023. Patient characteristics, source of infection, identified pathogens, treatment regimens, and outcomes were extracted from medical records. The primary outcome was clinical cure at 6 months; secondary outcomes included mortality, need for suppressive therapy, and adverse events.

Results: Sixty-six patients (median age 73 years; 47% female) received dalbavancin for orthopaedic/bone infections (56%), endocarditis (23%), vascular graft infections (6%), bacteraemia (6%), sacral ulcer infections (6%), and other infections (3%). The patients had significant comorbidities: diabetes (38%), malignancy (33%), chronic kidney disease (44%), and substance use disorders (17%)."Methicillin-susceptible" Staphylococcus aureus was the predominant pathogen (31% of isolates). Dalbavancin was prescribed to facilitate outpatient therapy (53%), address poor compliance (17%), or manage antibiotic intolerances (17%). Patients received a median of 2 doses (range 1-17). At 6-month follow-up, 62% achieved clinical cure, 18% remained on suppressive therapy, and 20% died, primarily from underlying conditions. Adverse events were infrequent (6%) and generally mild.

Conclusions: Dalbavancin achieved a 62% cure rate despite significant comorbidities, offering a safe alternative to inpatient care for elderly, comorbid patients.

Nocardiosis is caused by the Gram-positive bacterium Nocardia spp. The most common inborn error in immunity (IEI) associated with nocardiosis is chronic granulomatous disease (CGD). This case series highlights five cases of nocardiosis with a diagnosis of IEI other than CGD. P1, nine-year-old male child, diagnosed case of IL12RB1 deficiency, presented with seizures. MRI brain showed multiple ring-enhancing lesions. He was empirically treated with AKT and steroids for tuberculomas. Newer lesions on MRI brain prompted biopsy that showed acid-fast filaments on modified-ZN stain. Culture grew Nocardia spp. P2, 10-year-old male presented with cachexia, deep jaundice, abdominal distension with right pyopneumothorax and large splenic abscess. Splenic aspirate and pleural tap revealed the presence of Nocardia spp on culture and Nocardia cyriacigeorgica on MALDI-TOF. In view of disseminated nocardiosis, NBT/DHR test was advised which was normal, WES revealed homozygous IL12RB1 pathogenic variant. P3, nine-year male with refractory atopic dermatitis since three months of age. He had eosinophilia (10,000 cells/cumm) and hyper IgE (2360 IU/ml). He was diagnosed with DOCK8 deficiency on NGS. While being evaluated for BMT he had focal seizure with ataxia, MRI brain revealed the presence of cerebellar abscess. Biopsy revealed Nocardia spp. P4 and P5 were patients with Goods syndrome and nocardia pneumonia. Thus, isolation of nocardia at any age must prompt one to look for underlying IEI other than CGD as well. Extensive and invasive tests along with radiological tests need to be undertaken in patients with IEI to isolate and appropriately treat.

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.

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.