BMC Infectious Diseases最新文献

Objectives: To investigate the characteristics and inducing factors of atypical renal tuberculosis, and to improve the diagnosis of atypical renal tuberculosis.

Methods and materials: We collected medical records and observed the pathological sections of renal tissue performed after nephrectomy from 217 patients diagnosed with renal tuberculosis using Mycobacterium tuberculosis culture, or/and Mycobacterium tuberculosis DNA (TB-DNA) testing using FQ-PCR(Fluorescent Quantitative Polymerase Chain Reaction), or/and postoperative pathology in the urology department of Hebei Chest Hospital from March 25, 2013 to February 6, 2024. Based on their onset characteristics, we divided them into the typical group (145 cases) and the atypical group (72 cases), and analyzed the chief symptoms and characteristics. Logistic regression was used to analyze the relevant factors, and the differences were compared in pathological changes of kidney, ureter, and bladder tissues after surgery, to explore the mechanism leading to atypical symptoms of renal tuberculosis.

Results: ①In the typical group (66.82%), bladder irritation is the main clinical manifestation. In the atypical group (33.18%), there are no obvious symptoms of bladder irritation. The primary manifestations include localized pain, kidney discomfort, and secondary systemic or local disease signs.Additionally, the incidence rate among women in the atypical group is higher than in the typical group (p < 0.05).②Combined bladder tuberculosis is the only related factor of renal tuberculosis with severe urinary frequency, urgency, and dysuria as the main onset symptoms (p < 0.05). Only the LAM antibody and B lymphocyte counts were associated with the grouping of renal tuberculosis by logistic regression analysis (p < 0.05).③Bladder tuberculosis is more common in the typical group. At the same time, chronic inflammation is the main manifestation in the atypical group.

Conclusions: ①Atypical renal tuberculosis is an important part of renal tuberculosis. Its onset of symptoms is insidious and atypical, without obvious bladder irritation symptoms, which should cause high vigilance and attention.②Uncomplicated bladder tuberculosis is the direct cause of the absence of bladder irritation symptoms in atypical renal tuberculosis, and reduced humoral immune function, and tubercular virulence may be the relevant factors inducing the onset of atypical symptoms in renal tuberculosis.

Clinical trial: Not applicable.

Background: Early-onset prosthetic valve endocarditis (EO-PVE) is linked to poor in-hospital outcomes. Staphylococcus spp. poses a significant concern due to its higher mortality rates compared to other major infectious agents.

Objectives: Provide a more detailed, comprehensive evaluation of the clinical characteristics and in-hospital mortality predictors related to staphylococcal EO-PVE.

Methods: This observational, retrospective, single-center study was conducted at a tertiary hospital in Brazil from 1997 to 2019, spanning a 22-year period. A total of 105 consecutive cases of left-heart staphylococcal EO-PVE were analyzed.

Results: There was a predominance of coagulase-negative staphylococci prosthetic valve endocarditis (CoNS PVE) over Staphylococcus aureus prosthetic valve endocarditis (SAPVE) (76% and 24%, respectively). Prosthetic valve replacement for EO-PVE treatment was performed in 73% of cases. In-hospital mortality was 49%, with SAPVE associated with a higher in-hospital mortality than CoNS PVE (80% versus 43%, p < 0.001). In-hospital mortality predictors identified by univariate analysis included older age (p < 0.001), aortic prosthetic endocarditis (p < 0.001), peri-annular abscess (p = 0.002), SAPVE (p < 0.001), NYHA functional class III/IV (p = 0.02), previous combined myocardial revascularization with valve replacement surgery (p = 0.02), left ventricular dysfunction (p < 0.001), leukocytosis (p = 0.02), and higher C-reactive protein levels (p = 0.006). In a multivariate analysis, SAPVE was identified as an independent risk factor for in-hospital mortality (odds ratio [OR] 10.2; p = 0.006), whereas prosthetic valve replacement was associated with improved in-hospital survival (OR 0.2; p = 0.04).

Conclusion: Staphylococcal EO-PVE is associated with increased in-hospital mortality, particularly in SAPVE cases. In this study, all non-operated SAPVE patients died primarily due to fulminant septic shock. Prosthetic valve replacement was significantly linked to in-hospital survival, and only 5.7% of the study population survived without cardiac surgical intervention.

Clinical trial number: Not applicable.

Background: Preterm birth has become increasingly common over the past several decades. The underdeveloped immune systems place preterm infants at an increased risk of infections, often vaccine-preventable, compared to full-term infants. Despite the importance of immunizing preterm infants, research on vaccine safety, immunogenicity, and effectiveness in this population remains limited. This consensus article seeks to provide clear, evidence-based recommendations to improve vaccine coverage and timely immunization in preterm infants in Egypt.

Methods: A modified Delphi consensus approach was employed to develop evidence-based recommendations for preterm infant vaccination in Egypt. A panel of 18 experts, including pediatricians, neonatologists, and a pharmacist participated. The process covered 15 key vaccination topics, with 59 statements formulated based on a comprehensive literature review. A 5-point Likert scale was used to evaluate the statements, with ≥ 70% agreement threshold for consensus. Statements not meeting this threshold were revised and subjected to a second voting round. Final recommendations were established based on the achieved consensus.

Results: Our consensus included 59 statements. In the first round of voting, 63 statements were evaluated, with the panel reaching a consensus on 54 statements. Nine statements fell below the 70% agreement threshold and required a second round of voting. A second round was conducted, including these nine statements along with one newly added statement. Ultimately, five statements achieved consensus, while five were removed.

Conclusion: Establishing preterm vaccination guidelines is important for reducing mortality and morbidity in this high-risk population, especially in Egypt. This consensus emphasizes the need for timely immunization to minimize the risk of infections associated with delayed vaccination. Additionally, it identifies several areas requiring further research, ensuring that future updates can continue to refine and enhance immunization strategies for preterm infants.

Clinical trial number: Not applicable.

Background: This study aimed to explore the efficacy and safety of combination therapy with PEG-IFN α-2b and tenofovir amibufenamide (TMF) for the treatment of chronic hepatitis B (CHB).

Methods: This multicenter study enrolled 84 CHB patients, who received PEG-IFN α-2b (180 µg/weekly) and TMF (25 mg/day) for 48 weeks. Clinical and laboratory assessments were performed at baseline and at 12-week intervals (weeks 12, 24, 36, and 48). Serologic response (SR) was defined as hepatitis B surface antigen (HBsAg) loss (< 0.05 IU/mL), with or without HBsAg seroconversion (HBsAg < 0.05 IU/mL and HBsAb > 10 mIU/mL). Adverse events (AEs) were monitored at each assessment. Logistic regression and receiver operating characteristic curve analyses were used to identify predictors of HBsAg clearance.

Results: The combination therapy of PEG-IFN α-2b and TMF resulted in significant reductions in HBsAg levels from baseline at weeks 24, 36, and 48. At these time points, the proportion of patients with undetectable HBV DNA increased progressively, with the proportion reaching 94.7% at week 48. In the SR group, the baseline HBsAg and HBeAg levels were significantly lower than those in the non-serological response (NSR) group, with greater reductions in HBsAg observed at weeks 12 and 24. Multivariate analysis revealed that baseline HBsAg levels and the degree of HBsAg decline at week 24 were independent predictors of HBsAg loss, with odds ratios of 4.609 and 3.237, respectively. The diagnostic performance of baseline HBsAg levels and their decline at week 24 demonstrated areas under the curves (AUCs) of 0.856 and 0.821, respectively, with a combined AUC of 0.908. The cumulative HBsAg clearance rates were 25% in treatment-naïve patients and 26.7% in treatment-experienced patients. The most frequently reported AEs included fever, fatigue, rash, alopecia, elevated ALT and AST levels, neutropenia, and thrombocytopenia.

Conclusions: PEG-IFN α-2b and TMF combination therapy effectively reduced HBsAg levels in CHB patients. Baseline HBsAg levels and the magnitude of their decline by week 24 served as robust predictors of serological response, exhibiting high diagnostic value.

Background: Multidrug-resistant, rifampicin-resistant, and extensively drug-resistant tuberculosis (MDR-TB/RR-TB/XDR-TB) present significant treatment challenges, requiring effective and safe therapeutic regimens. This study aims to assess the efficacy and safety of a 24-week regimen that includes Delamanid (Dlm) for patients with these resistant forms of tuberculosis.

Methods: This was a single-arm, prospective, monocentric, observational trial. From June 2020 to January 2023, 29 patients meeting the inclusion criteria were selected from Hangzhou Red Cross Hospital. These patients received a treatment regimen that included Dlm. Data were collected on patient demographics, sputum culture conversion rates, and pulmonary lesion changes after 24 weeks. Additionally, adverse events (AEs) that occurred during treatment were recorded and analyzed.

Results: Out of the 29 patients, 26 completed the initial 24-week intensive phase treatment, with 2 patients withdrawing due to adverse reactions and 1 patient being lost to follow-up. The cohort included 11 MDR-TB, 3 RR-TB, and 12 XDR-TB patients. All 26 patients who were sputum culture-positive at baseline achieved culture conversion within the 24-week treatment period, resulting in a 100% conversion rate. Conversion was confirmed in all patients tested on solid media (18/18) and liquid media (8/8). The median time to sputum culture conversion was 34 days for solid and 70 days for liquid media. Imaging showed significant pulmonary lesion absorption in 21 cases and partial absorption in 3 cases. Improvements in pulmonary cavities were noted in 15 patients. A total of 108 AEs were reported, with the most common being liver function abnormalities (61.5%), anemia (50%), and leukopenia (42.3%). No serious AEs or deaths occurred, and 24 patients (92.3%) had favorable outcomes.

Conclusions: The regimen containing Delamanid during the initial 24 weeks intensive phase of treatment demonstrated high efficacy in achieving sputum culture conversion and showed an acceptable safety profile in MDR-TB/RR-TB/XDR-TB patients, offering a valuable treatment option for this difficult-to-treat population.

Trial registration: It registered in ICH GCP-US Clinical Trials Registry and the registration number is NCT04421495 and date of registration was June 9, 2020.