Infectious diseases (London, England)最新文献

Introduction: For public health purposes, it is essential to understand which population groups and their areas of residence are affected by a disease as COVID-19 and to what extent these groups are reached by preventive measures.

Aim: We investigated how individual-level and area-level characteristics are associated with COVID-19 morbidity and vaccine uptake.

Methods: A population-based observational study including the total adult population age 18 and older in Sweden from 1 January 2020 to 1 April 2022, except individuals living in nursing homes. Associations between both individual and area-level characteristics and COVID-19 morbidity (hospitalisation, admission to intensive care unit and death) and vaccine uptake were analysed using Cox proportional hazards regression and adjusted for age, sex, comorbidity and socioeconomic and demographic factors.

Results: In the fully adjusted model, the hazard ratio (HR) for COVID-19 hospitalisation was 34% lower for individuals living in the most affluent neighbourhoods (HR 0.66, 95%CI 0.63-0.68) compared to individuals in the most deprived neighbourhoods. For intensive care unit (ICU)-admission and COVID-19 death, the risks were 53% (HR 0.47, 95%CI 0.42-0.53) and 47% (HR 0.53, 95%CI 0.48-0.59) lower, respectively. When stratified by cross-classified sociodemographics, this pattern was consistent within all strata. A composite area-level measurement had a better predictive value compared to single measures.

Conclusions: Living in deprived neighbourhoods is associated with substantially higher risk of COVID-19 hospitalisation, ICU-admission, mortality and lower vaccine uptake. This risk factor remained strong even when taking individual level characteristics into account and within strata of individual-level factors.

Background: Infections of the aorta and its branches can occur either in native tissue, known as infective native aortic aneurysms (INAAs), or following vascular surgery involving native or prosthetic grafts, referred to as vascular graft or endograft infections (VGEIs).

Objectives: First, this study aimed to assess the all-cause on-year mortality of patients with INAAs and VGEIs. Second, this study described patients' characteristics and prognostic factors.

Methods: This observational study included patients hospitalised for INAA or VGEI, between 2014 and 2022, at Nancy University Hospital (France). Data were retrospectively collected from patients' medical record (ClinicalTrials.gov ID NCT05660733).

Results: Forty-seven patients were included in the INAAs group versus 40 in the VGEIs group. A history of immunosuppression or autoimmune disease were more frequent in INAAs patients. VGEIs patients had more chronic organ failure or cardiovascular pathology. The most commonly affected site was the infrarenal aorta, with thoracic involvement being more frequent in the INAAs group. Staphylococcus aureus was the most frequent identified pathogen (38.3% vs. 27.5%). There was no significant difference between groups in terms of all-cause 1-year mortality (40.4% in the INAAs group vs. 32.5% in the VGEIs group, log-rank test, p = .4803). The absence of surgery worsened the prognosis in the overall population (HR 2.8, 95% CI [1.2-6.3], p = .0125); this was also observed in the INAA group.

Conclusions: Despite different comorbidities and clinical presentations between groups, there was no significant difference in 1-year mortality. Surgical management appeared to be associated with improved outcomes.

Background: Infectious respiratory diseases significantly cause morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with limited diagnostic resources. This study explored the utility of lung ultrasound (LUS) paired with extra-pulmonary point-of-care ultrasound (POCUS) for differentiating infectious aetiologies in lower respiratory tract infections (LRTI).

Methods: This prospective cohort study was conducted at a tertiary care centre in India. We recruited consenting adults with suspected LRTI who underwent extended point-of-care lung ultrasound (EPLUS). The protocol included thoracic and abdominal views assessing for lung consolidations and B-lines, pleural effusion, pericardial effusion, focal splenic lesions, and abdominal lymphadenopathy and correlated these with patients' final diagnoses.

Results: We included 322 participants in our analysis cohort, which had a notable prevalence of previously existing chronic lung conditions (21%) and an HIV-prevalence of 5%. Infectious lung disease was identified in 48% of patients, comprising 35% with non-TB LRTI and 13% with TB. Non-infectious lung disease was present in 21% of patients. LUS detected consolidations in 75% and >3 B-lines in 72% of participants. LUS findings were mostly non-specific and prevalent across both infectious and non-infectious conditions. Extra-pulmonary ultrasound findings, such as pericardial effusion and splenic lesions, findings common in disseminated tuberculosis, were rare.

Conclusion: The study highlights the high sensitivity of LUS for detecting pulmonary changes but revealed low specificity to differentiate pulmonary conditions, especially in the presence of pre-existing comorbidities. Future research should explore the accuracy of combinations of clinical characteristics and ultrasound findings in algorithmic approaches, which may improve diagnostics in resource-limited settings.

Purpose: Acute undifferentiated febrile illness (AUFI) and acute encephalitis syndrome (AES) continue to be major public health concerns, particularly in rural areas with limited healthcare facility. We investigated the aetiological agents responsible for seasonal sporadic AUFI and AES cases in Northern India.

Method: The study included 4200 patient samples (April 2022 to March 2024), fulfilling the AUFI or AES case definition. Clinical samples were tested for IgM antibodies against dengue, chikungunya, Japanese encephalitis, scrub typhus, and leptospirosis. Further, Leptospira IgM ELISA positives (n = 79) were also tested by microscopic agglutination test (MAT) assay.

Results: In AUFI cases, scrub typhus was the predominant bacterial aetiology (24.6%, 593/2407) followed by leptospirosis (12.4%, 266/2151). Dengue (23.0%, 321/1398) was the leading cause among viral aetiologies. Similarly, among AES cases, scrub typhus (36% in cerebrospinal fluid and 34.3% in serum) remained the most common bacterial aetiology followed by leptospirosis (5.42%, 11/203). Whereas, chikungunya was the predominant viral cause (5.4%, 17/314) behind AES cases. Further, using MAT assay, 7.6% (6/79) of the AUFI samples tested positive for leptospirosis. The prevalent serogroups identified included L. interrogans serovars Australis, Pomona, Hebdomadis, Pyrogenes and Djasiman, and L. borgpetersnii serovar Tarassovi. Housewives constituted the primary risk group for leptospirosis infection, followed by individuals engaged in various farming practices.

Conclusion: This study identifies scrub typhus as the predominant and leptospirosis as the second most common infection in sporadic cases of AUFI and AES. Therefore, continuous monitoring of changing aetiologies is crucial for the effective implementation of targeted control and preventive measures for neglected tropical diseases.