BMC Infectious Diseases最新文献

Background: Staphylococcus aureus bacteremia (SAB) is a prevalent life-threatening infection often caused by methicillin-resistant S. aureus (MRSA). Up to 30% of SAB patients fail to clear infection even with gold-standard anti-MRSA antibiotics. This phenomenon is termed antibiotic-persistent MRSA bacteremia (APMB). The mechanisms driving APMB are complex and involve host phenotypes significantly impacting the immune response. Thus, defining early immune signatures and clinical phenotypes that differentiate APMB from antibiotic resolving (AR)MB could aid therapeutic success.

Methods: We assessed 38 circulating cytokines and chemokines using affinity proteomics in 74 matched pairs of vancomycin-treated SAB cases identified as ARMB or APMB after 5 days of blood culture.

Results: Unsupervised hierarchical clustering segregated APMB from ARMB based on differential levels of IL-10, IL-12p40, IL-13, CCL4, and TGFα. Additionally, CXCL1, CCL22 and IL-17A significantly differed between APMB and ARMB when correlated with diabetes, dialysis, metastatic infection, or cardiac vegetation. Combining immune signatures with these relevant clinical phenotypes sharply increased accuracy of discriminating APMB outcome to 79.1% via logistic regression modeling. Finally, classification-regression tree analysis revealed explicit analyte thresholds associated with APMB outcome at presentation especially in patients with metastatic infection.

Conclusions: Collectively, this study identifies previously unrecognized cytokine and chemokine signatures that distinguish APMB and ARMB at presentation and in the context of host clinical characteristics associated with increased disease severity. Validation of a biomarker signature that accurately predicts outcomes could guide early therapeutic strategies and interventions to reduce risks of persistent SAB that are associated with worsened morbidity and mortality.

Background: Systemic juvenile idiopathic arthritis (sJIA) accompanied with Brucella bloodstream and bone marrow infection is an exceedingly rare occurrence in clinical practice. Owing to the striking similarity in their clinical presentations, there is a propensity for misdiagnosis or underdiagnosis.

Case presentation: In this case, the pediatric patient underwent medical treatment across five different hospitals over a three-month period before receiving an accurate diagnosis and successful treatment. There are two primary factors contributing to this consequence. To begin with, Brucella exhibits slow growth, leading to initial blood cultures producing false negative results due to insufficient cultivation time. Additionally, sJIA and brucellosis present extremely similar clinical symptoms. In addition to arthritis, the child presented with a non-fixed erythematous rash that gradually resolved after fever subsided and was associated with increased IL-6 levels. Furthermore, both blood and bone marrow cultures displayed positive results after four days, and Brucella was identified through MALDI-TOF mass spectrometry. Combined with additional laboratory results and clinical symptoms, sJIA accompanied with Brucella bloodstream infection was ultimately diagnosed and effectively managed in our hospital.

Conclusion: It is crucial to emphasize that in cases of brucellosis infection, the identification of sJIA and brucellosis is of vital significance. Brucella can be isolated and cultured from blood and bone marrow within approximately two weeks, serving as the definitive indicator for diagnosing Brucella bloodstream infection. By reporting this case, we aim to share clinical experience, provide a more accurate and expedited diagnosis, as well as treatment for future patients encountering similar circumstances.

Background: Purulent pericarditis is a rare, life-threatening condition often caused by Streptococci, Staphylococci, Haemophilus species, or Mycobacterium tuberculosis. Coinfection cases are exceedingly uncommon. We aim to document and share this rare case through this case report.

Case presentation: We report the case of a 44-year-old woman with no significant past medical history who presented to the emergency department of Chang Gung Memorial Hospital, Linkou branch, at Taoyuan, Taiwan, in July 2024 with a 3-day history of chest discomfort, shortness of breath and fever. Imaging revealed pericardial and mediastinal fluid with gas. Pericardiocentesis drained the pericardial effusion and later identified Eikenella corrodens and Parvimonas micra via MALDI-TOF mass spectrometry. A history of fish bone impaction one month prior suggested an oral origin for the infection, although imaging revealed no esophageal perforation. The patient underwent pericardial drainage, video-assisted thoracoscopic surgery for abscess drainage, and four weeks of antibiotic treatment with ampicillin-sulbactam, leading to full recovery.

Conclusion: To our knowledge, this is likely the first documented case of purulent pericarditis caused by Eikenella corrodens and Parvimonas micra simultaneously. This case highlights the importance of a multidisciplinary approach and prompt management, including drainage and tailored antibiotic therapy, in mitigating the high mortality associated with purulent pericarditis.

Background: Leishmania infantum is the only prevalent Leishmania species in Europe and manifesting predominantly as cutaneous or visceral leishmaniasis, whereas new world species like Leishmania (L.) braziliensis are well known pathogens in mucocutaneous leishmaniasis. Mucosal leishmaniasis caused by L. infantum is a rare clinical condition with only few cases described in literature. In contrast to our case, mostly immunocompromised patients with no history of leishmaniasis are affected.

Case presentation: We describe the case of a 77-year-old German male who developed an ulcerous lesion of the tongue. As oral cancer was suspected, the patient underwent surgery. After suspected diagnosis of Leishmania spp. in histopathology, the patient was referred to our department for further diagnostics and treatment. Relapse from a cutaneous leishmaniasis acquired in Spain is likely, as L. infantum could be identified as the causative agent. The patient recovered after treatment.

Conclusions: Mucosal leishmaniasis caused by L. infantum is rare and usually mistaken for malignancy. As demonstrated, it can be preceded by cutaneous leishmaniasis of the immunocompetent. Due to possible dissemination systemic treatment should be applied.

Background: Isavuconazole has been used to treat invasive fungal infections, however, it is unclear whether the efficacy of isavuconazole is superior to that of voriconazole. The purpose of this meta-analysis was to assess the efficacy and safety of isavuconazole compared to voriconazole in treating invasive fungal infections.

Methods: Electronic databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, were searched to identify relevant studies. Studies evaluating the effect of isavuconazole in the treatment of patients with invasive fungal infections were included. Pooled rates of overall response, all-cause mortality, drug-related adverse events (AEs), and discontinuation due to drug-related AEs were calculated.

Results: Seven studies involving 890 patients were included. Meta-analysis showed that there was no significant difference between isavuconazole and voriconazole in overall response (risk ratio [RR]: 1.02, 95% confidence interval [CI]: 0.83 to 1.25, p = 0.86) and all-cause mortality (RR: 0.95, 95% CI: 0.78 to 1.16, p = 0.61). However, isavuconazole had a significantly lower incidence of drug-related AEs (RR: 0.70, 95% CI: 0.61 to 0.81, p < 0.001) and discontinuation due to drug-related AEs (RR: 0.56, 95% CI: 0.39 to 0.82, p = 0.003) compared with voriconazole. Trial sequential analysis (TSA) confirmed that the difference between isavuconazole and voriconazole in discontinuation due to drug-related AEs need further valiadation, but the results of other outcomes were conclusive.  < 0.001) and discontinuation due to drug-related AEs (RR: 0.56, 95% CI: 0.39 to 0.82, p = 0.003) compared with voriconazole. Trial sequential analysis (TSA) confirmed that the difference between isavuconazole and voriconazole in discontinuation due to drug-related AEs needs further validation, but the results of other outcomes were conclusive.

Conclusions: Our findings support the use of isavuconazole as the primary therapy for invasive fungal infections. More research is needed to compare the discontinuation rates of isavuconazole and voriconazole.

Background: Tuberculosis (TB) continues to pose a significant threat to global public health. Enhancing patient prognosis is essential for alleviating the disease burden.

Objective: This study aims to evaluate TB prognosis by incorporating treatment discontinuation into the assessment framework, expanding beyond mortality and drug resistance.

Methods: Seven feature selection methods and twelve machine learning algorithms were utilized to analyze admission test data from TB patients, identifying predictive features and building prognostic models. SHapley Additive exPlanations (SHAP) were applied to evaluate feature importance in top-performing models.

Results: Analysis of 1,086 TB cases showed that a K-Nearest Neighbor classifier with Mutual Information feature selection achieved an area under the receiver operation curve (AUC) of 0.87 (95% CI: 0.83-0.92). Key predictors of treatment failure included elevated levels of 5'-nucleotidase, uric acid, globulin, creatinine, cystatin C, and aspartate transaminase. SHAP analysis highlighted 5'-nucleotidase, uric acid, and globulin as having the most significant influence on predicting treatment discontinuation.

Conclusion: Our model provides valuable insights into TB outcomes based on initial patient tests, potentially guiding prevention and control strategies. Elevated biomarker levels before therapy are associated with increased risk of treatment discontinuation, indicating their potential as early warning indicators.

Background: Tuberculosis (TB) remains a significant health challenge among people living with HIV (PLHIV), underscoring the need for early diagnosis and prompt treatment. Hematological parameters have emerged as potential markers for predicting and monitoring TB disease. This study aimed to assess the utility of hematological parameters in predicting TB disease among PLHIV.

Methods: This retrospective cohort study was conducted at an Antiretroviral Therapy (ART) Centre in Gujarat, India, including PLHIV registered between January 2018 and March 2024. Hematological parameters, including hemoglobin levels, platelet counts, white blood cell differentials, and derived ratios (monocyte-lymphocyte ratio [MLR] and neutrophil-lymphocyte ratio [NLR]), were extracted from medical records. TB diagnosis was based on bacteriological confirmation or clinical criteria. Cox proportional hazards models and Kaplan-Meier survival analyses were performed to assess the association between hematological parameters and TB disease, adjusting for potential confounders.

Results: Among 810 PLHIV, 202 (25%) had TB disease. PLHIV with TB had a higher prevalence of anemia (91.6% vs. 60.0%, p < 0.001), leucocytosis (16.3% vs. 7.6%, p = 0.0004), and neutrophilia (25.2% vs. 9.4%, p < 0.0001) compared to those without TB. A higher MLR ratio (> 0.23) was associated with an increased risk of TB (HR: 5.44, 95% CI: 3.94-7.50, p < 0.001), independent of anemia. Anemia was also an independent predictor of TB (HR: 4.37, 95% CI: 2.72-7.02, p < 0.001).

Conclusions: Hematological parameters, particularly MLR ratio and anemia status, showed strong associations with TB disease among PLHIV. An MLR > 0.23 was associated with a 5.44-fold increased risk of TB, while anemia increased the risk by 4.37-fold. These readily available and cost-effective markers could enhance early TB detection and risk stratification in PLHIV, especially in resource-limited settings. Integration of these parameters into existing screening protocols may improve targeted interventions and patient outcomes.

Background: Human papillomavirus (HPV) is the cause of genital tract infections. This virus can cause diverse diseases, such as warts and anogenital cancers. Despite the WHO recommendations for HPV vaccination, there is no public HPV vaccination plan in Iran. Therefore, the prevalence of HPV infection in Iran is greater than that in countries with vaccination programs.

Objectives: We aimed to evaluate the prevalence of various HPV genotypes in genital specimens from patients with clinical symptoms in western Iran.

Methods: Between 2015 and 2023, 818 vaginal swabs and 26 genital wart samples from females and 28 genital wart samples from males were transferred to the Pars Pathobiology Laboratory (Kermanshah Province) for HPV evaluation. HPV genotyping was performed with two real-time PCR kits and one reverse hybridization kit during the study.

Results: Generally, 38.9% (340/872) of the participants were HPV positive. The prevalence rates of HPV in female vaginal swabs and genital wart samples were 37.4% (306/818) and 61.5% (16/26), respectively; however, the prevalence for males was 64.3% (18/28). The most common high-risk genotype was HPV50 (51, 52, 53, 56, 58, and 59) (26.5%), and among the low-risk genotype was HPV6 (62.9%).

Conclusions: The prevalence of HPV-positive patients was greater than that in some neighboring countries and other regions of Iran. This high prevalence may be due to a lack of public vaccination. Therefore, we should conduct regular screenings for all age groups of females. Males can act as carriers for the virus, and informing men about this infection is essential.

Background: Contamination of contact lenses has always been correlated with contamination of lenses and lens storage cases (LSCs), with higher loads of microorganisms in LSCs. The aim of the present study is to better understand non-compliance with strict hygiene rules in asymptomatic contact lens wearers, and to track circulating germs in LSCs that may affect the integrity of the eye.

Methods: Demographic and behavioral data were collected from 111 asymptomatic lens wearers belonging to different medical faculties in Tunisia. Seventy LSCs were subjected to microbiological investigations, by direct examination and culture, in order to identify contaminating micro-organisms. The Richness and evenness of the species encountered were assessed to measure biodiversity on a local and international scale.

Results: The study population was characterized by an average age of 22.8 ± 2.4 years and 95% female gender. Microbiological contamination accounted for 81.42% of LSCs, with only one case positive for Acanthamoeba spp. The Candida spp. fungal elements (20.0%) and Staphylococcus coagulase negative bacteria (60.5%) were the predominant microorganisms. Biodiversity markers namely: Simpson (0.802) and Shannon-Weiner (1.895) diversity indices were high in comparison to other studies. Monthly lens renewal (OR = 1.333, p = 0.040) and soft lens wear (OR = 4.66, p = 0.066) enhanced the installation of fungal elements.

Conclusions: The behaviors of contact lens wearers observed in this work corroborate those of all studies of contact lens wearers. The complexity of the recommended procedure and poor understanding of the instructions may explain any imperfections. This study highlights a high level of biodiversity in LSCs, and the strains in circulation are almost potentially pathogenic for humans.

Background: Thermophilic Campylobacter species are important causes of human gastroenteritis and inappropriate use of antimicrobials has led to the emergence of antimicrobial resistance (AMR). In Rwanda, data is limited on the prevalence and AMR carriage rate of Campylobacter strains. This study aimed at assessing the prevalence and antimicrobial susceptibility profiles of Campylobacter species among isolates obtained from different clinical settings in Kigali city, Rwanda.

Methods: This cross-sectional study used a purposive sampling method to collect 385 stool samples from consenting patients attending the Microbiology Department at Kigali University Teaching Hospital (CHUK), Nyarugenge District Hospital, Muhima and Biryogo Health Centers (HC). Campylobacter species were isolated using culture and characterized with biochemical tests and multiplex Polymerase Chain Reaction (PCR) for species confirmation. Antimicrobial susceptibility testing (AST) with six antimicrobials [ciprofloxacin (CIP), tetracycline (TET), chloramphenicol (CHL), streptomycin (STR), erythromycin (ERY), and gentamicin (GEN)] was carried out by using Kirby-Bauer disk diffusion.

Results: The overall prevalence of Campylobacter spp. was 7.0% (27/385) and the highest prevalence of 77.8% (21/27) was recorded at Biryogo HC. The prevalence of C. jejuni and C. coli were 92.6% (25/27) and 7.4% (2/27), respectively. Infection was significantly associated with diarrhea (p < 0.0001). Campylobacter isolates showed high resistance to STR (85.2%, 23/27), followed by ERY (66.7%, 18/27), and CIP (37.1%, 10/27). The isolates were sensitive to CHL at 88.9% (24/27), TET at 66.7% (18/27), and GEN at 66.7% (18/27).

Conclusion: The prevalence of campylobacteriosis in Kigali City is not negligible and is associated with diarrhea. Campylobacter strains isolated from clinical settings were resistant to commonly used antimicrobials. Larger studies will provide insights into the national status of Campylobacter-related AMR. Routine monitoring of antimicrobial use is recommended to mitigate this public health threat. Molecular analyses of resistant strains are warranted to characterize the genomic drive of antibiotic resistance.