BMC Infectious Diseases最新文献

Background: The Global Point Prevalence Survey (PPS) of antimicrobial consumption and resistance has been widely undertaken to combat the global threat of antimicrobial resistance (AMR). This study was conducted in alignment with the Global-PPS in three tertiary care hospitals in Kerman, Iran, to evaluate antimicrobial consumption patterns.

Methods: The study was conducted from January 2020 to January 2021 in Afzalipour, Shafa, and Shahid Bahonar Hospitals. Data were collected using the standardized Global-PPS method at three different points throughout the year to minimize bias. Information on antimicrobial prescriptions, primary diagnosis, prophylaxis, therapy indications, and treatment type were documented. Antimicrobial prevalence was calculated using the total number of admitted patients as the denominator and those on antimicrobial regimens as the numerator.

Results: The point prevalence of antimicrobial consumption in adult wards was 65.6% in Afzalipour Hospital, 42.3% in Shafa Hospital, and 78.7% in Bahonar Hospital. Non-penicillin beta-lactams, macrolides, lincosamides, and streptogramins were the most frequently prescribed antibiotic classes. Approximately 80% of prescriptions had explicit reasons documented, and targeted antibiotic therapy rates varied between 7.7% and 44.8% across hospitals.

Conclusions: Antimicrobial consumption in Kerman's tertiary care hospitals exceeded national and global levels, indicating an urgent need for interventions to promote rational antibiotic use. Infection control committees must implement rigorous monitoring measures to reduce antimicrobial resistance. Ongoing surveillance and targeted interventions are essential to curb the rising rates of antimicrobial resistance in the region.

Background: Routine childhood immunization against varicella-zoster virus has led to a dramatic reduction in the incidence of primary varicella. However, there are rare, yet significant cases reported of reactivated Oka-strain varicella, primarily in immunocompromised hosts.

Case presentation: A 16-year-old female with Hodgkin's lymphoma developed a vesicular rash shortly after completing all chemotherapy treatment. Swabs obtained from the vesicles were positive for varicella-zoster virus. By the time of hospitalization, the patient developed a disseminated rash involving multiple dermatomes. Subsequent polymerase chain reaction confirmed Oka vaccine-strain varicella-zoster virus. The patient had previously received a primary series of immunizations against varicella in 2008 and 2012, with her 2nd dose given 11 years prior to her development of vaccine-strain herpes zoster and 10 years prior to her diagnosis of Hodgkin's lymphoma, respectively. The patient was treated with parenteral acyclovir upon hospitalization and monitored clinically for cutaneous disease progression as well as sequelae. After 8 days of inpatient treatment, her rash had stopped spreading with no new lesions. All earlier lesions had crusted over. No serious sequelae of disease such as pneumonitis, hepatitis, encephalitis, or meningitis occurred, and she made a complete recovery.

Conclusions: There are individual and community-wide benefits to childhood immunization against varicella. This case highlights an unusual presentation of disseminated vaccine-strain herpes zoster in an adolescent with secondary immunodeficiency 11 years after completing primary immunization. In addition, this case informs pediatricians of complications that can arise in immunized subjects if they become immunosuppressed years later. The only way to distinguish between wild-type and vaccine-strain herpes zoster was by viral genotyping. Providers should be cognizant of potential vaccine virus reactivation in their differential. Considerations for work-up and management should include infection control and viral resistance in refractory cases.

Background: Tuberculosis is a highly prevalent disease in India, while Histoplasmosis, an emerging disease, is often underreported due to limited resources in developing countries. Coinfection with both these organisms is rarely documented in immunocompetent host. Due to overlapping symptoms, it can be easily missed and treatment delays are not uncommon.

Case presentation: Here, we report a case of a 62-year-old male with a chronic history of intermittent fever and dry cough, splenomegaly, lymphadenopathy, and persistent pancytopenia. He was diagnosed with tuberculosis with cartridge-based nucleic acid amplification test (CBNAAT) positivity from a paratracheal lymph node biopsy. Simultaneously, a bone marrow biopsy revealed Histoplasmosis and the patient was started on dual treatment (Itraconazole and antitubercular drugs). After an initial response, the patient developed new space-occupying cerebral lesions. CSF histoplasma antigen was also positive. The reason for treatment failure was likely to be drug interaction (suboptimal levels of itraconazole due to rifampicin). The patient received liposomal amphotericin and subsequently put on a modified antitubercular treatment regimen to avoid interaction with itraconazole. At 2-month follow-up, the patient's condition significantly improved with a substantial resolution in CNS lesions.

Conclusions: Histoplasmosis and tuberculosis have overlapping symptoms, diagnosing one does not preclude the possibility of other, even in non-HIV patients. Clinicians should also be vigilant about potential drug interactions.

Background: Recreational drug use has been identified as a significant risk factor for the transmission of human immunodeficiency virus (HIV). This behavior is particularly prevalent among young men who have sex with men (YMSM). However, limited research has been conducted to investigate the correlation between recreational drug use and HIV incidence within this population.

Objective: To examine HIV incidence and explore the association between recreational drug use and HIV incidence among YMSM.

Methods: A retrospective cohort study was conducted by a local non-governmental organization (NGO) among MSM aged 18-24 years from October 2017 to December 2023 in Tianjin, China. Participants were included if they had at least two HIV test records during this period. HIV incidence density and its 95% confidence interval (CI) were calculated using person-years (PYs) with a Poisson distribution. Risk factors for HIV incidence were identified using univariable and multivariable Cox proportional hazards regression models.

Results: A total of 56 HIV seroconversions were reported with 2901.9 PYs, resulting in an overall incidence density of 1.9/100 PYs (95% CI: 1.4-2.4). Among YMSM who do not use recreational drugs (YMSM-URD), the incidence density was 1.1/100 PYs (95% CI: 0.5-1.6), while it was 2.8/100 PYs (95% CI: 1.9-3.7) among those who do use recreational drugs (YMSM-RD). Adjusted for confounders, factors associated with HIV infection included recreational drug use (adjusted hazard ratio = 2.6, 95% CI = 1.4-4.7) and unprotected anal intercourse in the past six months (adjusted hazard ratio = 2.3, 95% CI = 1.2-4.4).

Conclusions: Recreational drug use and unprotected anal intercourse significantly increase the risk of HIV infection. To effectively mitigate the spread of HIV, interventions should focus on these risk factors by employing HIV counseling and testing clinics, collaborating with NGOs focused on MSM, and establishing peer education programs aimed at YMSM.

Background: Extrapulmonary tuberculosis (TB) is a relatively rare form of tuberculosis infection, accounting for approximately 15% of all tuberculosis infections. Lymph nodes are the most commonly affected sites, while involvement of the parotid gland is extremely rare.

Case presentation: We present the case of a 65-year-old male patient with a one-month history of a left parotid mass. The patient has a history of diabetes and long-term smoking, and a chest X-ray revealed secondary fibrotic pulmonary tuberculosis, while sputum smears were culture-negative for Mycobacterium tuberculosis (Mtb). The parotid mass was surgically removed and subjected to routine HE staining, acid-fast staining, and PCR molecular testing for Mtb. The final diagnosis was Warthin's tumor of the parotid gland with concomitant tuberculosis. One month after removal of the parotid mass, the patient's chest CT showed cavitary tuberculosis. Subsequently, the patient received anti-tuberculosis treatment; however, due to severe gastrointestinal adverse effects, the patient stopped the medication in less than a month and did not receive regular treatment. Four months after stopping the medication, the patient's pulmonary tuberculosis progressed and worsened.

Conclusion: Combined tuberculosis in Warthin's tumor is extremely rare, with only 14 cases reported to date. However, the specific pathogenesis of this condition is not yet fully understood, and the preliminary treatment and prognosis have not been conclusively determined. Early diagnosis of tuberculosis, standardized and effective use of anti-tuberculosis drugs, and personalized treatment are crucial in the management of tuberculosis. We have reviewed the treatment progress of this rare disease and analyzed the potential pathogenesis of the condition. Furthermore, we have summarized the current understanding of the pathogenesis of tuberculosis, drug resistance mechanisms, and the latest treatment advances. These studies have important clinical implications for better understanding and treating extrapulmonary tuberculosis and tuberculosis within Warthin's tumor of the parotid gland. This comprehensive analysis sheds light on the complexities of tuberculosis and provides valuable insights for improved management and care of affected individuals.

The first outbreaks of coronavirus CoV, SARS-CoV and MERS-CoV have occurred in China and Saudi Arabia over the past decade, respectively. From the end of 2019, a great battle began by the world scientific community against SARS-CoV-2, the virus that caused COVID-19, a pathology that generated devastating consequences on all existing continents. Several mutations have already been detected in the structure of the virus, which have been responsible for the generation of many types of variants since the detection of the first COVID-19 virus identified in China. The worrisome mutations arising from the first genome of SARS-CoV-2 have been intensively studied. Some mutations increase the transmissibility of the disease through Spike, the protein responsible for binding the virus in the human cell. Among the numerous strains, the most discussed are called by the WHO as "variants of concern". This study aims to review if COVID-19 severity may be variant dependent. Our study found tree publications that associate severity of COVI-19 symptoms to different SARS-CoV-2 variants. The most part of publications do not establish which variant is being expressed during studies. More studies with this focus are needed for a better understanding of the disease and respective variants.

Background: Tracheobronchial mucormycosis is a fatal opportunistic infection that mainly causes airway stenosis and is difficult to manage clinically.

Case presentation: We report a case of severe tracheal stenosis caused by tracheobronchial mucormycosis in a 37-year-old female with a history of hyperthyroidism. She developed agranulopenia after oral methimazole administration and subsequently experienced asthma with dyspnea. Bronchoscopy, sputum culture, colony mass spectrometry, and microscopic cotton orchid staining confirmed tracheobronchial mucormycosis. The patient received venous-venous extracorporeal membrane oxygenation (VV-ECMO) and prolonged intratracheal instillation of amphotericin B (AmBD), combined with amphotericin B liposome (L-AmB) and isavuconazole intravenous infusion, ultimately resulting in successful treatment.

Conclusion: VV-ECMO combined with prolonged intratracheal instillation of AmBD is an effective method for the treatment of tracheobronchial mucormycosis.

Background: Staphylococcus aureus infective endocarditis (IE) in native valves is associated with high mortality rates and is prone to various complications, including embolic strokes, which often result in poor prognoses. Contezolid, a novel oxazolidinone antibiotic, exhibits superior therapeutic efficacy with a reduced risk of hematologic toxicity. However, there are currently no reports on the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) IE accompanied by cerebrovascular complications.

Case presentation: We reported a young female patient with MSSA IE accompanied by cerebrovascular complications. She was diagnosed through blood culture, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cranial imaging, but the therapy using piperacillin-tazobactam and vancomycin failed. Therefore, the combination therapy of cefazolin and linezolid was applied, and her body temperature gradually returned to normal, and the infection symptoms were controlled. However, the platelets (PLT) dropped to 114 × 10⁹/L, so contezolid was used as an alternative therapy. Subsequently, the PLT returned to normal. The patient received contezolid therapy for 3 weeks and was free of adverse events during the 2 years of follow-up.

Conclusion: This was the first case of MSSA IE accompanied by cerebrovascular complications in a young woman, who was successfully treated with an antibiotic regimen containing contezolid, without the need for surgical intervention, demonstrating remarkable efficacy and safety.

Background: Streptococcus suis (S. suis) is a zoonotic disease that is transmitted to humans via contact or oral route. Although the major clinical presentation of this pathogen is known to be meningitis, S. suis infective endocarditis (IE) has recently emerged as a clinical manifestation of increasing interest. Echocardiography may be an underutilized modality for evaluating patients with S. suis bacteremia.

Objective: The primary objective was to estimate the prevalence of S. suis IE in patients with S. suis bacteremia. The secondary objective was to investigate the predictors, echocardiographic features, and clinical outcomes of S. suis IE in patients with S. suis bacteremia.

Materials and methods: This single-center retrospective study was conducted at Siriraj Hospital - Thailand's largest university-based tertiary referral center. Adult patients (aged > 18 years) who were admitted to our center with confirmed diagnosis of S. suis bacteremia during January 2007 to September 2023 were included. Prevalence is reported as percentage and confidence interval. Baseline characteristics and clinical manifestation were compared between the IE and non-IE groups. Factors found to be statistically significant were further analyzed using binary logistic regression analysis to identify univariate predictors of S. suis IE.

Result: A total of 71 patients with S. suis bacteremia were included in this study. The prevalence of S. suis IE was 26.8% (95% confidence interval: 17.85-38.05). Perivalvular complications and significant valvular regurgitation were found in 52.6% and 80.0% of patients, respectively. Thirteen of 19 patients (68.4%) required valvular surgery according to standard guidelines. By univariate analysis, dyspnea, new murmur, immunologic phenomenon, and heart failure were predictors of S. suis IE in patients with S. suis bacteremia.

Conclusion: The results of this study revealed a sizable prevalence of S. suis IE in patients with S. suis bacteremia, and there were high rates of both valvular damage and perivalvular complications. Our results strongly suggest that echocardiography may be indicated to evaluate for S. suis IE in patients diagnosed with S. suis bacteremia. Reclassification of S. suis from an atypical organism to a typical organism should be considered.

Background: Soil-transmitted helminthiases (STH) and schistosomiasis are parasitic neglected tropical diseases (NTDs) of significant public health importance globally, including Nigeria. Urogenital schistosomiasis is highly endemic in Apojola, a rural community in Ogun State, southwest Nigeria, but data on STH and intestinal schistosomiasis in the neglected community are lacking.

Objectives: To determine the prevalence and intensity of STH and intestinal schistosomiasis and the risk factors associated with the infections in Apojola.

Methods: The study was community-based and cross-sectional. A structured questionnaire was used to obtain information on socio-demographic, personal, and household WASH characteristics of the study population. Stool samples were collected and processed for parasitological examination using the triplicate Kato-Katz (K-K) smears.

Results: A total of 283 individuals (males, 50.2%; females, 49.8%) aged 3 to 65 years (mean age ± S.D.: 19.6 ± 14.8 years) participated in the study. No case of intestinal schistosomiasis was recorded in the study, while the overall prevalence of any STH was 38.2%: A. lumbricoides (24.0%) and hookworms (25.8%). Prevalence of infection was not significantly different between males and females for any STH (40.1% vs. 36.2%, χ² = 0.473, p = 0.492); A. lumbricoides (23.2% vs. 22.7%, χ² = 0.012, p = 0.913); or hookworms (28.2% vs. 23.4%; p = 0.360; χ² = 0.839), but significantly varied with age for any STH (χ² = 22.225, p = 0.002); A. lumbricoides (χ² = 16.354, p = 0.022); or hookworms (χ² = 20.001, p = 0.006). The intensity of infection was neither associated with gender nor age and was mostly light. Walking barefoot, toilet type (absent/bush), and irregular washing of fruits and/or vegetables before consumption were significantly associated with STH.

Conclusion: Our data indicate that intestinal schistosomiasis is not prevalent in Apojola and that the community is a moderate-risk area for STH. Hence, the current annual preventive chemotherapy for STH (PC STH) with albendazole or mebendazole in school-aged children (SAC) through the school-based delivery programme should be extended to non-enrolled SAC and pre-SAC using other delivery platforms. This should be complemented with regular and effective health education campaigns as well as water, sanitation, and hygiene (WASH)-related interventions.