BMC Infectious Diseases最新文献

Background: Cutaneous leishmaniasis (CL) is a parasitic disease endemic to the Americas, with a high prevalence in Peru. In resource-limited settings where liposomal amphotericin B is often unavailable, amphotericin B deoxycholate (AmB-d) remains a second-line option. However, data on its safety and effectiveness in children are scarce. This study describes the clinical experience of 20 paediatric patients with CL treated with AmB-d in a referral centre in Peru.

Methods: We conducted a retrospective descriptive study of patients ≤14 years with confirmed localised CL who had failed parental sodium stibogluconate (Sb⁵⁺ IM/IV) treatment and received intravenous AmB-d at Hospital Cayetano Heredia (Peru) between January 2000 and December 2007. Patients received daily treatment until all lesions met the early cure criteria, defined as complete reepithelialization at the time of discharge. We collected demographic, clinical, and laboratory data, including the mean daily dose, cumulative dose, and adverse events (AEs).

Results: We included 20 patients with a mean age of 4.9 years (±3.7), and 90% had lesions on the face. Nineteen patients (95%) completed treatment and achieved early clinical cure. Mean cumulative dose was 19.8 mg/kg (±5.7) and mean treatment duration was 28.8 days (±7.1). A total of 63.2% (12/19) of patients achieved clinical cure with a cumulative dose below 20mg/kg, and 84.2% with a dose below 25 mg/kg. Systemic adverse events (AEs), including fever (90%) and anorexia (70%), occurred mainly between the second and third weeks of treatment (83%). Six patients (30%) developed an increase in serum creatinine and nine (45%) developed hypokalemia.

Conclusions: Intravenous amphotericin B deoxycholate (AmB-d) is an effective and well-tolerated second-line treatment for paediatric American CL unresponsive to Sb⁵⁺ treatment. Despite the need for high cumulative doses, prolonged treatment durations, and frequent AEs, side effects were mild to moderate, transient, and did not lead to treatment discontinuation.

Background: Hepatitis B Virus (HBV) remains a significant global public health challenge, particularly among pregnant women due to the risk of vertical transmission. Despite increasing reports of HBV in Nigeria, data specific to Idah, Kogi State, are limited. This study aimed to estimate the prevalence and identify predictors of HBV infection among pregnant women in this setting.

Methods: A crosssectional survey was conducted among 245 pregnant women attending their first antenatal clinic visit at Specialist Hospital, Idah, Kogi State, Nigeria (March-June 2024). HBV infection was defined as HBsAg positivity confirmed by rapid test and ELISA neutralization. Independent variables included age, marital status, educational level, exposure to sharp objects, alcohol use, tribal marks, and multiple sexual partners. Adjusted logistic regression models were fitted using penalized likelihood methods in R (v4.4.2). Model fit was assessed with likelihood ratio and Wald tests, Hosmer-Lemeshow goodnessoffit, calibration slope/intercept, and AUC. Predictive performance was evaluated using confusion matrix metrics with Wilson score confidence intervals. Missing data were addressed using single imputation under a Missing at Random (MAR) assumption.

Results: HBV prevalence was 5.7% (95% CI: 3.2-9.4%). Significant predictors included marital status (OR = 23.66, 95% CI: 1.04-654.93), exposure to sharp objects (OR = 23.88, 95% CI: 1.52-3519.22), tribal marks (OR = 9.29, 95% CI: 1.84-99.56), and multiple sexual partners (OR = 66.79, 95% CI: 4.80-1665.01). The model demonstrated excellent discrimination (AUC = 0.9635) and good calibration (Hosmer-Lemeshow χ² = 4.29, df = 8, p = 0.83). At the Youden threshold (0.30), sensitivity was 0.9610 (95% CI: 0.93-0.98), specificity 0.6429 (95% CI: 0.39-0.85), PPV 0.9780 (95% CI: 0.95-0.99), NPV 0.5000 (95% CI: 0.27-0.73), F1 score 0.969, and balanced accuracy 0.8019.

Conclusion: HBV infection among pregnant women in Idah was significantly associated with marital status, cultural practices (tribal marks), exposure to sharp objects, and multiple sexual partners. The predictive model demonstrated strong discrimination and calibration, supporting its potential utility for HBV risk stratification in antenatal care. However, modest specificity and NPV highlight the need for cautious interpretation and external validation in larger, multisite cohorts.

Background: Crimean-Congo Hemorrhagic Fever (CCHF) is a high-fatality, tick-borne viral zoonosis endemic to several regions of the Eastern Mediterranean, including Iraq. This study aimed to characterize the spatiotemporal patterns, clinical spectrum, and exposure-specific risk factors of CCHF in Wasit Governorate, Iraq.

Methods: A retrospective analytical study was conducted using surveillance data from 369 suspected cases reported in Wasit Governorate between 1 January 2022 to 30 June 2025. Laboratory confirmation was based on RT-PCR and serological criteria. Demographic, clinical, hematological, and exposure variables were analyzed using SPSS version 25. Descriptive statistics, Chi-square tests, and binary logistic regression were applied to identify significant predictors. Spatial distribution was visualized using QGIS.

Results: Among 369 suspected cases, 98 (26.6%) were laboratory-confirmed. Confirmed cases peaked in 2023 and exhibited a seasonal distribution between April and September. The case fatality rate was 11.5%, with no deaths in 2024. Clinical predictors of confirmation included injection site bleeding (OR = 4.33), ocular hemorrhage (OR = 3.10), and severe thrombocytopenia (OR = 2.90). Adults aged ≥ 30 years had significantly higher odds of infection. Key risk factors included recent animal slaughter (OR = 3.74), tick bites (OR = 4.85), and handling raw meat (OR = 2.39). Human-to-human transmission was negligible.

Conclusion: CCHF remains a recurrent and seasonally driven public health threat in Wasit, primarily mediated through zoonotic exposures. Hemorrhagic manifestations and thrombocytopenia are critical clinical indicators. These findings underscore the urgent need for integrated One Health surveillance, targeted vector control, and risk communication strategies to mitigate transmission in endemic settings.

Clinical trial: Not applicable.

Introduction: Neonatal fungemia represents a substantial contributor to morbidity and mortality in 25-30% of neonatal intensive care units (NICUs), particularly affecting preterm or low-birth-weight infants. The immune systems of neonates, particularly those who are preterm, are underdeveloped, making them highly susceptible to infections like fungemia.

Cases: In the neonatal intensive care unit (NICU), bloodstream infections (BSIs) were identified in 18 out of 72 cases, accounting for 25% of the total. Of these, five cases were attributed to fungal infections, constituting 27.7% of all infections over the past three months. This report concentrates on these five neonatal cases, which were diagnosed with fungemia, a form of bloodstream infection caused by Candida and yeast-like filamentous fungi, particularly affecting newborns. The non-albicans Candida (NAC) species, specifically Candida tropicalis, Candida krusei, and Candida pelliculosa, as well as the arthroconidial yeast-like filamentous fungus Saprochaete capitata, have been associated with increased morbidity and mortality rates. A significant proportion of these cases were outborn, with potential associations to risk factors such as maternal vaginal candidiasis or lapses in infection control measures during childbirth. All cases were identified within the first week of life and were consequently classified as early-onset neonatal sepsis. In addition to maternal risk factors, several neonates were delivered preterm, exhibited low birth weight, experienced respiratory distress, and required ventilatory support. Unfortunately, only two cases resulted in recovery and discharge, while the remaining three did not survive.

Discussion & conclusions: The prompt identification and management of conditions are essential for optimizing patient outcomes. This study highlights the critical role of non-albicans Candida species and other yeast-like invasive fungi as key factors in the onset of early neonatal sepsis within neonatal intensive care units (NICUs).

Background: Following the initial description of Mycobacterium florentinum in 2005, very few clinical cases have been reported and the optimal antimicrobial treatment and clinical outcomes are uncertain. Amikacin liposome inhalation suspension (ALIS) has received approval for the treatment of Mycobacterium avium/intracellulare complex (MAC) pulmonary disease. However, there is little experience with its use for infections caused by less common nontuberculous mycobacteria (NTM). Moreover, the awareness of uncommon adverse effects is still limited.

Case presentation: A 69-year-old female patient suffering from nodular bronchiectatic Mycobacterium florentinum pulmonary disease was treated with azithromycin, ethambutol, and rifampicin, administered three times per week. After 13 months, owing to treatment failure, the therapy was changed to ALIS, moxifloxacin, and clofazimine. This resulted in rapid and sustained culture conversion. Concurrently, the patient exhibited increased cough and sputum, which was consistent with a clinical diagnosis of aspergillosis, as confirmed by evidence of Aspergillus fumigatus in respiratory specimens and a significant increase in serum Aspergillus IgG antibody levels. Following a six-month course of antifungal therapy, a marked improvement in the patient's symptoms was observed.

Conclusions: As with MAC pulmonary disease, combination antimicrobial therapy including ALIS was successful in a patient affected by a difficult-to-treat pulmonary infection caused by Mycobacterium florentinum, a rare NTM pathogen. Combination antibiotic treatment including ALIS may also be considered for other difficult-to-treat, non-MAC NTM- pulmonary diseases. During treatment, patients should be monitored for the emergence of Aspergillus co-infection.

Background: The long-term impact of the COVID-19 pandemic on the distribution pattern of respiratory pathogens in China was unknown. Our study aimed to determine the multipathogen profiles and co-infection characteristics among patients with acute respiratory infections (ARIs) in the post-COVID-19 era in Shenzhen, China.

Methods: This multi-center cross-sectional study was conducted among patients with ARIs from five sentinel hospitals from November 1, 2022 to June 30, 2023 in Shenzhen, China. The collected respiratory samples were subjected to targeted next-generation sequencing for high-throughput screening of 108 respiratory pathogens. Multi-stage logistic regression models were built to infer interactions between pathogens at the individual level.

Results: The median [IQR] age of 1890 patients included was 31.8 [23.7, 45.2] years. The proportions of positivity on any pathogen and co-infection were 84.0% (1587/1890) and 41.4% (782/1890). Children < 5 years and school-age children have the highest viral (78.0%, 99/127) and bacterial positive proportion (65.5%, 114/127). Influenza virus (IFV), SARS-CoV-2, and human rhinovirus (HRV) were the three leading viral pathogens, and Haemophilus influenzae (H. influenzae), Staphylococcus aureus (S. aureus), and Streptococcus pneumoniae (S. pneumoniae) were the three leading bacterial pathogens. The three leading co-infection pathogens were S. pneumoniae combined with H. influenzae (4.6%, 86/1890), IFV with S. aureus (4.5%, 85/1890) and with H. influenzae (3.3%, 62/1890). The proportions of positivity on IFV, enterovirus, SARS-CoV-2, H. influenzae, S. aureus, and S. pneumoniae in outpatients were higher than those in inpatients, while the proportions of positivity on human parainfluenza virus (HPIV), human metapneumovirus (HMPV), Pseudomonas aeruginosa, Acinetobacter baumannii, Mycoplasma pneumoniae, and Legionella pneumophila in inpatients were higher than those in outpatients. RSV, IFV, HPIV, human adenovirus, and HRV were the top five viral pathogens among hospitalized children before, during, and after the COVID-19 pandemic in Shenzhen. Virus‒virus interactions, such as IFV combined with SARS-CoV-2 (OR = 20.3 [95% confidence interval (CI): 7.2-57.0]) and with HRV (OR = 7.2 [95% CI: 3.5-15.0]) exhibited competitive effects. Bacteria-bacteria interactions exhibited synergistic effects such as Moraxella catarrhalis combined with S. pneumoniae (OR = 0.3 [95% CI: 0.2-0.5]).

Conclusions: There were differences in the pathogen profiles among patients with different ages, pneumonia groups, and case types. Virus‒virus interactions presented competitive effects, while bacterium‒bacterium interactions exhibited synergistic effects.

Background: Policy decisions may rely on mathematical modelling to predict intervention impacts. Information for key model parameters is limited for most enteric pathogens. To support informed modeling, we aimed to characterize incidence, severity, and duration for ten enteric pathogens - adenovirus 40/41, astrovirus, Campylobacter jejuni and C. coli, Cryptosporidium, norovirus GII, rotavirus, sapovirus, Shigella, heat-stable enterotoxin-producing enterotoxigenic Escherichia coli (ST-ETEC), and typical enteropathogenic E. coli (tEPEC) - among children aged 2 years or younger in South America, southeast Asia, and sub-Saharan Africa.

Methods: We analyzed stool specimens from MAL-ED, a multisite longitudinal birth cohort with active surveillance of children in South America, southeast Asia, and sub-Saharan Africa. We defined unique infections using longitudinal test results, attributed etiologies to diarrheal episodes, calculated infection rates and disease progression probabilities, and characterized age-based trends.

Results: Most pathogens had peak infection rates around 7 to 9 months of age, with incidence gradually decreasing in the second year of life. In contrast, Cryptosporidium and ST-ETEC incidence plateaued after 9 months of age instead of declining. Shigella incidence continually increased in the first two years of life. The likelihood of developing diarrhea decreased with age for adenovirus 40/41, Campylobacter jejuni and C. coli, and tEPEC. The likelihood of attributable diarrhea becoming severe decreased with age.

Conclusions: The age at peak infection burden and peak disease burden were not necessarily the same for a given pathogen. Each pathogen evaluated had its own distinct age trends. These results could support informed modelling of impacts of interventions for specific enteric pathogens, particularly in low-resource settings.

Clinical trial number: Not applicable.