BMC Infectious Diseases最新文献

Background: Brucellosis is a neglected and common zoonotic disease. Infections in humans result in a granulomatous disease that can affect many organs with various presentations and complications. Aortitis and thyroiditis are rare complications with limited data. This case discusses the successful medical therapy alone in the management of aortitis and the development of Brucella thyroid disease through autoimmune mechanisms.

Case presentation: This is a 58-year-old male patient from Jordan. He presented with prolonged fever and was found to have brucellosis associated with abdominal aortitis, subacute thyroiditis, bilateral sacroiliitis, and lumbar spondylodiskitis. We review his clinical course with an emphasis on the complications of aortitis and thyroiditis. The aortitis was managed conservatively with antibiotics alone, avoiding surgical or endovascular intervention. The subacute thyroiditis was associated with autoimmune markers and was detected in the setting of an underlying pre-existing multinodular goiter. After a long follow-up period of three years, the patient continued to do well.

Conclusion: Physicians should be aware of the complications of aortitis and thyroiditis in patients with brucellosis. Medical therapy alone can be an option for some patients with aortitis who are at high surgical risk. In addition, the development of subacute thyroiditis in the setting of brucellosis might be secondary to an autoimmune response.

The hepatitis B virus (HBV) is a major public health problem worldwide. Sexual intercourse, heterosexual and homosexual, is an important factor in HBV transmission in adults. This study develops a fractional-order mathematical model to describe the spread of HBV, using fractional calculus with a Mittag-Leffler kernel to account for memory effects and hereditary properties of biological systems. The adult population is divided into the groups of susceptible, infected, carrier, and recovered, on the basis of sex and sexual habits. The model incorporates HBV-related disability using gender-specific probabilities that capture long-term functional impairments among carriers. We derive the basic reproduction number (R₀) and analyze the disease-free equilibrium (E₀). Theoretical results include conditions ensuring existence and uniqueness of solutions and the Hyers-Ulam stability of the system. Sensitivity analysis of R₀ identifies infection rates among same-sex partners, contact frequency, and immunity levels as major factors influencing HBV dynamics. Numerical simulations based on the generalized Mittag-Leffler kernel illustrate the model's behavior over time. The findings suggest that strengthening immunization programs, reducing the number of carriers, and promoting safe sexual practices can effectively control HBV transmission. The study highlights the value of fractional-order models for capturing complex disease processes and evaluating long-term health outcomes within affected populations.

Background: Antimicrobial resistance poses challenges for physicians, who must balance individual patient care and public health when prescribing antibiotics. Machine learning-based computerized decision support systems (ML-CDSS) are increasingly proposed to aid in this challenge. We aimed to assess physicians' decision-making in a common bacterial vs. viral infection scenario, and the impact of an ML-CDSS on it.

Methods: We administered an online scenario-based survey to physicians (N = 211), mainly pediatricians (67.8%). The estimated response rate was 33-40%. Each participant encountered four sore throat scenarios, corresponding to one of four McIsaac scores. Participants estimated the probabilities of bacterial infections and determined treatment strategies. This sequence occurred both before and after simulated hypothetical ML-CDSS interventions, in the form of a probability of bacterial infection output.

Results: The average probability estimates of bacterial infection under the four McIsaac scenarios were monotonically increasing: (1) 25.6% (95% CI 22.8-28.4%), (2) 43.8% (40.6-46.7%), (3) 65.1% (62.2-67.0%), and (4) 69.1% (66.3-71.8%). Furthermore, empiric treatment was generally overprescribed: (1) 11.4% (2) 38.4% (3) 65.8% (4) 73.0%. These estimates and treatment percentages are higher than expected given the relevant scientific literature. The interventions had substantial effects on probability estimates and empiric prescription; e.g. reducing average estimates by up to 14% points and lowering odds of antibiotic prescription by a factor 0.42.

Conclusions: Overestimation of bacterial infections and subsequent antibiotic overprescription are common, particularly under conditions of clinical uncertainty. These tendencies can be mitigated through ML-CDSS interventions, as demonstrated in a scenario-based survey setting. Our findings provide initial support for the design of ML-CDSS tools and their integration into primary care, pending further validation in clinical trials. Additionally, they support policy initiatives aimed at clarifying default clinical actions in situations of diagnostic uncertainty.

Clinical trial: Not applicable.

Background: Sepsis-related liver injury (SRLI) is a common complication of sepsis, yet its mechanisms are unclear and the association between serum sodium (SNa) and SRLI has been rarely investigated.

Methods: This retrospective cross-sectional study utilized data from the MIMIC-IV database, focusing on adult intensive care unit (ICU) patients diagnosed with sepsis. The primary outcome was SRLI. SNa levels were categorized into hyponatremia, normonatremia, and hypernatremia groups based on clinical cutoffs for statistical analysis. Binary logistic regression was used to assess the independent association between SNa and SRLI, and the Generalized Additive Model (GAM) was applied to verify potential nonlinear associations. Sensitivity analyses were conducted to ensure the robustness of the results, and subgroup analyses were performed.

Results: Among 11,809 adult patients with sepsis (57.2% male; mean age 65.8 ± 17.1 years), the prevalence of SRLI was 42.5%. Multivariable binary logistic regression showed that SNa was inversely associated with SRLI (adjusted odds ratio [aOR] 0.99; 95% confidence interval [CI] 0.98-0.99; P < 0.05). GAM analysis indicated a nonlinear association with a saturation effect between SNa and SRLI, with a threshold at 135 mmol/L. At SNa ≤ 135 mmol/L, SNa was inversely associated with SRLI, whereas the association was not statistically significant at SNa > 135 mmol/L. Subgroup analyses were generally consistent, with a stronger inverse association observed among patients with cirrhosis.

Conclusion: In critically ill adults with sepsis, SNa showed a nonlinear inverse association with SRLI, with a threshold around 135 mmol/L. Incorporating sodium into clinical assessment and stratification may be informative; multicenter prospective cohorts are warranted to confirm clinical utility.