BMC Infectious Diseases最新文献

Background: Adolescents with HIV (AWH) frequently exhibit impaired growth, which manifests as stunting and wasting. We studied trajectories in leg-length (appendicular), sitting (axial), and standing height among AWH on antiretroviral therapy (ART), determining peak height velocity (PHV) and age at PHV (aPHV).

Methods: Analyses used VITALITY trial data from Zimbabwe and Zambia (PACTR20200989766029), which recruited AWH (11-19 years) established on ART to determine whether vitamin D₃/calcium supplementation improves bone health. The study enrolled participants between January and December 2021. Weight-for-age and height-for-age z-scores (WAZ/HAZ) were calculated from 12-weekly anthropometry over 96 weeks. Height trajectory analyses used SuperImposition by Translation And Rotation (SITAR) methods adjusting for height, tempo (aPHV) and velocity. Linear associations between vitamin D/calcium supplementation, HIV-specific factors, WAZ, HAZ, and SITAR parameters were determined.

Results: Overall, 842 participants (53·2% female; median age 15·5 [IQR:13·2-17·9] years), were taking ART for median 9·8(IQR:6·3-12·3) years. Mean(SD) HAZ was 1·21(1·05) in females, -1·68(1·05) in males. Overall, 251(29·8%) AWH were stunted (HAZ < -2) and 253(30%) wasted (WAZ < -2). Standing, appendicular and axial aPHVs were: Female 13·4, 13·3, 13·9 years; Males 15·3, 15·0, 15·8 years. Unsuppressed viral-load(VL) and delayed ART initiation (age > 4-years) were associated with later aPHV and shorter axial height in females. In all, unsuppressed VL had a more negative effect on aPHV for axial (Females: β = 0·39 years [95%CI:0·12,0·65]; Males: β = 0·45 [95%CI:0·10,0·80]) than appendicular growth (Females: β = 0.31 [95%CI 0·08,0·53]; Males: β = 0·2 [95%CI:-0·17,0·56]). Conversely, delayed ART initiation was more negatively related to aPHV for appendicular (Females: β = 0·25 [95% CI:0·08,0·43]; Males: β = 0·63 [95%CI:0·32, 0·93] than axial growth (Females: β = 0·13 [95%CI:-0·08,0·34]; Males: β = 0·56 [95%CI:0·28,0·86]. Lower HAZ and WAZ were associated with lower height, later aPHV and lower PHV. At 48-week vitamin-D₃/calcium supplementation had no effect on the growth pattern.

Conclusion: Unsuppressed viral load and delayed ART-initiation predicted later aPHV. Stunting and wasting were associated with attenuated growth velocity and later aPHV. Adolescents with HIV experience persistent linear growth impairments, potentially persisting into adulthood.

Trial registration: (PACTR20200989766029|| http://www.pactr.org/ ); First registered on 03/09/2020.

Background: Chronic infection with Clonorchis sinensis (C.sinensis) has been associated swith the development of intrahepatic cholangiocarcinoma (ICC); however, the relationship between C.sinensis and hepatocellular carcinoma (HCC) remains uncertain.

Methods: This study examined 120 patients with liver cancer in the clonorchiasis endemic area of Hengzhou, Guangxi, China. The type of cancer, the differentiation grade according to Edmondson Steiner's classification, and the pathological characteristics of HCC were determined through postoperative tissue biopsy. C.sinensis infection was detected by measuring serum specific IgG antibody, and hepatitis B virus (HBV) infection was determined by detecting serum HBsAg and HBV DNA in HCC tissues. The C.sinensis infection rates in control groups were drawn from the local general population based on previous surveys. The association between C.sinensis infection and HCC was analyzed by comparing the differences in C.sinensis infection rates between the two groups.

Results: Of the patients evaluated, 98 (81.7%) had HCC, 21 (17.5%) had ICC, and 1 (0.8%) had comorbidity of HCC/ICC. Among the HCC patients, 24 (24.5%) were solely infected with HBV, 71 (72.4%) were C. sinensis seropositive, and 3 (3.1%) showed no evidence of infection. C. sinensis seropositive rates in HCC patients are much higher than in general outpatient and non-liver cancer inpatients (χ² = 141.92, p < 0.001), as well as in the local residents (χ² = 82.61/21.38, p < 0.001). There were no significant differences in the pathological type, differentiation grade, and lesion composition between the tumor associated with C.sinensis/HBV mono- and co-infection (p > 0.05). Among the patients with C.sinensis-related HCC, 8 (8.2%) were solely C.sinensis seropositive, while 63 (64.3%) were co-infected with HBV. Infection with C. sinensis and HBV has a significant impact on the pathological types of liver cancer (χ² = 22.86, p < 0.001).

Conclusions: These findings indicate that HCC still accounts for the majority of liver cancer in this region. In addition to being most commonly related with HBV infection, HCC may also be related to C. sinensis infection. Co-infection of C. sinensis and HBV may enhance the development of HCC in this area.

Clinical trial: Not applicable.

Background and aim: Severe fever with thrombocytopenia syndrome (SFTS) is a fatal tick-borne infectious disease lacking effective treatments or vaccines. Early identification of prognostic factors is essential for optimizing clinical management. This study investigated the predictors for mortality in SFTS patients.

Methods: We conducted a retrospective multicenter cohort study of 413 SFTS patients hospitalized in South Korea from 2013 to 2024. Clinical and laboratory data were comprehensively analyzed to evaluate associations between in-hospital mortality and various inflammatory, immune, and nutritional biomarkers. Cox regression and time-dependent receiver operating characteristic (ROC) analyses were performed to identify risk factors.

Results: 413 patients diagnosed with SFTS were included and In-hospital mortality was 17% (70/413). Multivariate Cox regression identified older age (HR: 1.042; 95% CI: 1.014-1.071), elevated PT(INR) (HR: 109.57; 95% CI: 19.79-606.57), and lower prognostic nutritional index (PNI) (HR: 0.937; 95% CI: 0.886-0.990) as early predictors of mortality. Time-dependent ROC analysis demonstrated predictive accuracy, with AUCs of 0.512 for age, 0.857 for PT(INR), and 0.694 for PNI at 30 days. Kaplan-Meier analysis revealed significant survival differences for patients stratified by PNI (< 40.75), PT(INR) (≥ 0.97), and age (≥ 59 years).

Conclusions: PNI, PT(INR), and age were identified as key early predictors of mortality in SFTS. PNI, as a novel biomarker, was found to be a useful index for risk level and treatment strategies in SFTS patients.

Clinical trial number: Not applicable.

Background: As in much of sub-Saharan Africa, substantial HIV testing gaps remain in South Africa, particularly among adult men ages 20-35, young people ages 15-24 and key populations. Innovative strategies, such as HIV self-testing (HIVST), are needed to reach such under-served populations. We evaluated a range of HIV self-test kit distribution models' potential to reach adult men, young people and key populations in South Africa, to inform targeted approaches.

Methods: This cross-sectional study used data from community and facility-based HIV self-test kit distribution models implemented from October 2017 to April 2020. Self-test kits were distributed as part of the Unitaid-funded Self-Testing AfRica (STAR) programme. Data were collected from individuals who obtained self-test kits through five distribution models. Frequencies and proportions were used to describe the characteristics of the study populations and self-test kit distribution approaches.

Results: Over 2.5 years, 1 071 065 self-test kits were distributed across the five models. Community-based distribution accounted for 63% of total kits distributed, while the private sector (primarily workplace) accounted for 26%. Distribution at public sector health facilities accounted for 7% and distribution through the key population and secondary distribution models accounted for 2% each. Of those obtaining kits, and for whom we collected previous testing data (n = 771 612, 72%), 11% had never tested for HIV, 29% had not tested for at least a year, 41% had tested within the last 4-12 months and 19% had tested within the preceding three months. More men (64%) than women obtained self-test kits across all distribution models. The majority (80%) of men obtaining self-test kits were aged 20-40 years, and primarily received these at public transport terminals (36%), workplaces (18%) and hotspots (14%). A small proportion of men was reached through female sex workers.

Conclusions: This analysis of programme data enabled us to identify HIV self-test kit distribution models that are best suited to reach specific priority and under-tested populations, particularly adult men and young people. Models/sub-models that reach self-test users where they live, work and spend time, are likely to result in higher HIVST uptake. Study findings can inform future HIVST scale-up in South Africa.

Aim: To study the prevalence of recurrent urinary tract infections (UTIs) and its associated factors in female staff of reproductive age group in a medical college in central Kerala.

Introduction: Recurrent UTIs can be defined as ≥ 3 episodes of UTIs within a period of 12 months. Females with recurrent UTIs have lower health-related quality of life compared to the general population; the incidence of UTI in women of reproductive age group is very common. This study focused on female employees of reproductive age group in a private medical college.

Methods: A cross-sectional study was done among female staff of reproductive age group in a private medical college in central Kerala, with a sample size of 417. All female staff (18-49 years) were given a questionnaire and asked to fill it out. All those who filled out the questionnaire were included in the study according to both inclusion and exclusion criteria. Data entry and analysis were performed via Microsoft Excel 2019 and SPSS version 22.0.

Result: Our study of 417 participants revealed a prevalence of recurrent UTIs of 22.30% (95% CI = 18.3- 26.3%). Recurrent UTI was significantly associated with daily water intake, urination frequency, holding urine, foul-smelling vaginal discharge, constipation, pre-coital urination, and pre- and post-intercourse vaginal hygiene. Also, occupation was found to be significantly associated with recurrent UTI, with cleaning staff having higher odds.

Conclusion: Our study found the prevalence of recurrent UTI in 417 population as 22.30%. Prevention of recurrent UTI requires a daily intake of > 2 L of water and personal & sexual hygiene. Reducing recurrent UTIs enhances quality of life. Educating female staff is crucial.

Background: Patients with kidney disease (KD) are at high risk of contracting COVID-19 and developing severe disease. There is still a lack of guidance regarding the treatment of COVID-19 in patients with KD. The safety and effectiveness of Azvudine in treating COVID-19 patients with KD remain unknown.

Methods: This study included 32,864 COVID-19 patients from nine centers in Henan Province, China. After applying the exclusion criteria and 2:1 propensity score matching, 438 and 219 participants in the Azvudine and Paxlovid groups, respectively, were subjected to analysis.

Results: Kaplan-Meier analysis revealed no significant differences in all-cause death or composite disease progression between the Azvudine and Paxlovid groups (all p values > 0.05). The same results were obtained in the Cox regression analysis after baseline characteristics adjustment. Three different sensitivity analyses contributed to the robustness of these findings. Subgroup analysis revealed that patients treated with Azvudine had a lower risk of composite disease progression than patients treated with Paxlovid did among patients with moderate disease (p = 0.016, HR: 0.51, 95% CI: 0.27-0.96). Safety data indicated that there was no difference in the incidence of most adverse events. Compared with the Paxlovid group, the Azvudine group had a lower incidence of hypophosphatemia (p = 0.008) and a lower PLT count (p = 0.045). Moreover, during the 15-day follow-up since drug administration, higher concentrations of lymphocytes were detected in the Azvudine group.

Conclusions: This study is the first to report that the safety and effectiveness of Azvudine are not inferior to those of Paxlovid in COVID-19 patients with KD. This study provides additional treatment options for COVID-19 patients with KD.

Background: Opportunistic infections (OIs) in patients with advanced HIV disease remain a serious health issue, particularly in low-and middle-income countries.

Objectives: This study aims to describe the clinical characteristics and factors associated with mortality among hospitalized advanced HIV-infected men who have sex with men (MSM).

Methods: A prospective cross-sectional study was conducted at the Hospital for Tropical Diseases in Ho Chi Minh City between March and June 2023. Data was collected through interviews and medical record reviews. A multivariate logistic regression model was employed to assess factors associated with hospitalization outcomes, with statistical significance set at p < 0.05.

Results: The study included 121 participants, with 61.3% aged 25-34 years and 42.2% classified as underweight. Only 35.5% of patients received OI preventive treatment. Comorbidities were noted as follows: hepatitis B (12.4%), hepatitis C (2.5%), and syphilis (43.8%). A total of 41.3% of patients had at least one OI, with Mycobacterium tuberculosis being the most common (46.3%), followed by Pneumocystis jirovecii pneumonia (44.6%) and Cryptococcus neoformans (19%). Sepsis was present in 20.7% of patients. The in-hospital mortality rate was 19%. Factors significantly associated with mortality included being underweight, HBV coinfection, C. neoformans infection, lack of OI preventive treatment, and sepsis.

Conclusion: The study reveals a high inpatient mortality rate among advanced HIV-infected MSM, even among relatively young patients. Increased mortality was associated with being underweight, having sepsis, HBV coinfection, C. neoformans infection, and not receiving OI preventive treatment.

Background: Bloodstream infections with the non-fermenting Gram-negative organisms Stenotrophomonas maltophilia, Elizabethkingia spp. or Chryseobacterium spp. are observed in nosocomial settings. Comparative description of their clinical presentation, microbiological characteristics, treatment options and outcomes remain to be investigated.

Methods: We performed a retrospective single-centre analysis of bloodstream infections with the abovementioned three organisms from 1 Jan 2012 to 30 Jun 2024.

Results: A total of 349 distinct encounters (from 322 unique patients) were identified with bacteraemia. Stenotrophomonas maltophilia was the commonest (197/349, 56.4%), followed by Elizabethkingia spp. (127/349, 36.4%) and Chryseobacterium spp. (25/349, 7.2%). Prior carbapenem exposure was observed in 59.9% of cases. The majority were related to central lines (58.2%). Most cases were nosocomial in onset (82.5%), and a third were from the intensive care unit (32.1%). A significant proportion of our Stenotrophomonas maltophilia (32.8%) and Chryseobacterium spp. (22.7%) isolates were resistant to levofloxacin, while a majority of the organisms retained susceptibility to trimethoprim-sulfamethoxazole (TMP-SMX) and minocycline. Dual antibiotics were used in a minority of encounters (23/349, 6.6%). Mortality was high across infections with the three organisms, but highest amongst those with Stenotrophomonas maltophilia bacteraemia (41.6%), followed by Elizabethkingia spp. (29.9%) and Chryseobacterium spp. (20.0%).

Conclusions: Stenotrophomonas, Elizabethkingia or Chryseobacterium spp bacteraemia was associated with significant mortality. Most cases were nosocomial in acquisition, with prior carbapenem exposure or indwelling central catheters. Fluoroquinolone resistance was common for Stenotrophomonas maltophilia and Chryseobacterium spp., but less prevalent in Elizabethkingia spp., while TMP-SMX and minocycline retained susceptibility. Monitoring these trends would be critical in guiding empiric therapy for these organisms.

Background: Rabies is an acute and lethal zoonotic disease caused by the rabies virus (RABV). After onset, there are no effective drugs or treatment methods.

Case presentation: A 49-year-old female from Hefei, Anhui Province, China, presented to a local hospital with fever, pruritus, chest distress, and shortness of breath. During the consultation, the patient exhibited agitation and was later admitted to the intensive care unit (ICU) in the local hospital for endotracheal intubation and mechanical ventilation due to worsened agitation and dyspnea. Cerebrospinal fluid (CSF) and blood samples were collected and pathogenic microorganism identification was performed by culture and mNGS. However, all results were negative. In addition, the patient did not display typical rabies-specific symptoms such as aerophobia, hydrophobia or photophobia from onset to admission. Subsequently, saliva samples were collected for mNGS detection following consultation with experts at our hospital. Nucleic acid sequences uniquely aligned to the rabies virus (RABV) were identified in these samples. The result was further confirmed by local Center for Disease Control and Prevention (CDC) through RT-qPCR which detected part of the N gene of RABV in the saliva sample. The patient was then transferred to the ICU for isolation. Unfortunately, the patient died on the 10th day of admission due to multiple organ failure. The detection of human rabies virus IgG antibodies reported positive during the advanced stage of the disease during the hospitalization. We consistently verified with the patient's family member that there was no clear history of animal bites and no history of RABV vaccination. Furthermore, we performed phylogenetic analysis of partial L and G gene sequences of RABV obtained by mNGS (designated HFG23-L and HFG23-G, respectively), the results showed that both HFG23-L and HFG23-G belonged to the China I lineage, and shared 99.7% similarity with the Fengtai strain isolated from dogs in Beijing.

Conclusions: The identification of unique RABV sequence through mNGS in the patient's saliva sample suggested that mNGS could serve as a valuable screening tool for the etiological diagnosis of rabies, especially when timely laboratory testing was unavailable or when patients lacked non-specific prodromal symptom and clear exposure history.

Background: Uropathogenic Escherichia coli (UPEC) is the predominant cause of urinary tract infections (UTIs), and the recurrence of these infections poses significant treatment challenges.

Objective: This study aimed to compare the phylogroups, biofilm formation, virulence factors, and antibiotic resistance of UPEC strains in patients with recurrent versus non-recurrent UTIs in Hamadan City, Western Iran.

Materials and methods: A total of 110 E. coli isolates were collected from urine cultures across three major hospitals and laboratories. The isolates were confirmed through biochemical tests, and their antibiotic resistance profiles were evaluated using the disk diffusion method. Biofilm production was assessed using the microtiter plate method, while virulence genes and phylogroup determination were analyzed via PCR. Real-time PCR was employed to compare the expression levels of the pap and fimH virulence genes.

Results: The results indicated that 73% of isolates were from non-recurrent UTI patients, with a higher incidence in females and children under 10 years. A significant difference was detected in the underlying diseases and the expression of the pap between the recurrent and non-recurrent groups. Antibiotic resistance was notably significant, particularly against Ampicillin-sulbactam, Trimethoprim-Sulfamethoxazole, Nalidixic acid, and Ciprofloxacin, with 77% of strains classified as multi-drug resistant (MDR). Despite differences in the rates of ESBL production between recurrent (53%) and non-recurrent (42.5%) strains, no significant differences were observed in antibiotic resistance, biofilm formation, virulence factors, or phylogroups between the two groups. Phylogenetic analysis revealed a predominance of phylogroups B2 and D, with high genetic diversity among the isolates.

Conclusion: The study highlights the traits of UPEC strains in recurrent and non-recurrent UTIs, showing high antibiotic resistance and genetic diversity among isolates. The study found notable differences in underlying diseases and the expression of the pap gene between recurrent and non-recurrent groups, suggesting that these factors may play a crucial role in the recurrence of infections. Further investigation into these differences could enhance our understanding and management of recurrent UTIs.