BMC Infectious Diseases最新文献

Background: The global burden of HIV and AIDS continues to significantly impact public health, particularly in Sub-Saharan Africa. This study investigates the spatial distribution and associated risk factors of HIV prevalence in Botswana using data from the 2021 Botswana AIDS Impact Survey (BAIS V).

Methods: The analysis included 12,653 adults aged 15-64 years and employed chi-square tests, multilevel mixed-effects regression, and spatial analysis techniques. HIV prevalence estimates were visualized through choropleth maps, and spatial autocorrelation was analyzed using Anselin Local Moran's I in ArcGIS 10.8.2 software.

Results: Findings revealed that 18% (ARR 95% CI: 0.15-0.23) of the surveyed population were people living with HIV (PLWH), with females disproportionately affected (66.8%). Females were 1.63 times more likely to be living with HIV compared to males (ARR 1.63, 95% CI: 1.52-1.76), and individuals aged 35-44 years (ARR 10.59 95% CI 8.96-12.52) were at the highest risk compared to the 15-24 year group. Lower education levels, rural residency, marital status (single), age (middle to late adulthood 35-54 years) and females were identified as key determinants of HIV infection. Spatial analysis showed Central Mahalapye as the district with the highest HIV prevalence rate (33.7%). Further, a high HIV prevalence cluster was found in the northeastern region of Botswana, while urban districts like Gaborone had significantly lower rates (11.2%).

Conclusions: These findings emphasize the role of socio-demographic and spatial factors in shaping HIV risk. Intensified targeted interventions, particularly for females, individuals with lower education, and rural populations, are recommended to reduce HIV transmission and mitigate the epidemic's impact in Botswana.

Background: Low blood absolute lymphocyte count (ALC) may predict severe COVID-19 outcomes. Knowledge gaps remain regarding the relationship of ALC trajectory with clinical outcomes and factors associated with lymphopenia.

Methods: Our post hoc analysis of the Therapeutics for Inpatients with COVID-19 platform trial utilized proportional hazards models to assess relationships between Day (D) 0 lymphopenia (ALC < 0.9 cells/uL), D0 severe lymphopenia (ALC < 0.5 cells/uL) or lymphopenia trajectory between D0 and D5 with mortality and secondary infections, and with sustained recovery using Fine-Gray models. Logistic regression was used to assess relationships between clinical variables and D0 lymphopenia or lymphopenia trajectory.

Results: D0 lymphopenia (1426/2579) and severe lymphopenia (636/2579) were associated with increased mortality (aHR 1.48; 1.08, 2.05, p = 0.016 and aHR 1.60; 1.20, 2.14, p = 0.001) and decreased recovery (aRRR 0.90; 0.82, 0.99, p = 0.033 and aRRR 0.78; 0.70, 0.87, p < 0.001 respectively). Trial participants with persistent D5 lymphopenia had increased mortality, and increased secondary infections, and participants with persistent or new lymphopenia had impaired recovery, as compared to participants with no lymphopenia. Persistent and new lymphopenia were associated with older age, male sex; prior immunosuppression, heart failure, aspirin use, and normal body mass index; biomarkers of organ damage (renal and lung), and ineffective immune response (elevated IL-6 and viral nucleocapsid antigen levels). Similar results were observed with severe lymphopenia.

Conclusions: Lymphopenia was predictive of severe COVID-19 outcomes, particularly when persistent or new during hospitalization. A better understanding of the underlying risk factors for lymphopenia will help illuminate disease pathogenesis and guide management strategies.

Background: Cirrhosis has been pointed out as a clinical entity that leads to worse clinical prognosis in COVID-19 patients. However, this concept is controversial in the literature. We aimed to evaluate clinical outcomes by comparing patients with cirrhosis to those without cirrhosis in a Brazilian cohort.

Methods: Data from 20,164 COVID-19 inpatients were collected from 41 hospitals in Brazil between March to September 2020 and March 2021 to August 2022. We compared 117 patients with cirrhosis to 632 matched controls. A propensity score model was used to adjust for potential confounding variables, incorporating some predictors: age, sex at birth, number of comorbidities, hospital of admission, whether it was an in-hospital clinical manifestation of COVID-19, and admission year. Closeness was defined as being within 0.16 standard deviations of the logit of the propensity score.

Results: The median age was 61 (IQR 50-70) years old, and 63.4% were men. There were no significant differences in the self-reported symptoms. Patients with cirrhosis had lower median hemoglobin levels (10.8 vs. 13.1 g/dl), lower platelets (127,000 vs. 200,000 cells/mm3), and leukocyte counts, as well as lower median C-reactive protein (63.0 vs. 76.0 p = 0.044) when compared to controls. They also had higher mortality compared to matched controls (51.3% vs. 21.7%, p < 0.001). They also had higher frequencies of admission in an intensive care unit (51.3% vs. 38.0%, p = 0.007), invasive mechanical ventilation (43.9% vs. 26.6%, p < 0.001), dialysis (17.9% vs. 11.1%, p = 0.038), septic shock (23.9% vs. 14.9%; p = 0.015) and institution of palliative care (19.7% vs. 7.4%; p < 0.001).

Conclusions: This study has shown that COVID-19 inpatients with cirrhosis had significantly higher incidence of severe outcomes, as well as higher frequency of institution of palliative care when compared to matched controls. Our findings underscore the need for these patients to receive particular attention from healthcare teams and allocated resources.

Introduction: Antimicrobial resistance is a global issue, with the World Health Organization identifying it as one of the greatest threats to public health, with an estimated 4.95 million deaths linked to bacterial AMR in 2019. Our study aimed to determine the prevalence of mortality among multidrug-resistant organism (MDRO)-infected patients in state hospitals and major specialist hospitals and to identify risk factors that could be associated with mortality outcomes.

Methods: This is a cross-sectional study performed at 28 hospitals under the Ministry of Health, Malaysia, involved in the National Surveillance of Multidrug-Resistant Organism, which surveys 6 MDROs (Acinetobacter baumanii, extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae, carbapenem-resistant Entrobacterales (CRE), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE)).

Results: In terms of mortality, 9.6% (n = 951) of the patients died overall, whereas 90.4% (n = 8931) of the patients survived. Healthcare-acquired infection (HCAI) poses a high risk of mortality, with an adjusted odds ratio (aOR) of 2.91 (95% CI: 2.15-3.94). The presence of sterile specimens was significantly associated with increased mortality risk (aOR: 2.33, 95% CI: 2.02-2.68). Gram-negative bacteria had a greater mortality risk (aOR 1.63 95% CI: 1.37-1.93), whereas Acinetobacter baumanii had the highest prevalence of 30.7% (3033) among the 6 MDRO organisms isolated. Patients in medical-based departments had a greater mortality risk (aOR: 1.47, 95% CI: 1.22-1.75).

Conclusion: HCAIs, Gram-negative bacteria, sterile specimens, medical-based departments and state hospitals have been shown to be associated with increased mortality risk in patients with MDRO infections. Improved surveillance and reporting mechanisms are necessary to better understand the burden of MDRO infections and guide research funding allocation.

Background: To assess the value of combined Monocyte Distribution Width (MDW) and Procalcitonin (PCT) detection in diagnosing and predicting neonatal sepsis outcomes.

Methods: This retrospective study, conducted from January 2022 to December 2023.A retrospective analysis of 39 neonatal sepsis and 30 non-infectious systemic inflammatory response syndrome (SIRS) cases was conducted. MDW, PCT, and CRP levels were compared. Relationships between variables were analyzed with Pearson correlation and Cox regression models; diagnostic performance was assessed using ROC curves.

Results: MDW, PCT, and CRP were significantly elevated in sepsis cases (p < 0.001). In non-survivors, MDW was higher and correlated with CRP, PCT, and SNAP scores. MDW was identified as an independent predictor of 28-day mortality. Optimal MDW, PCT, and CRP cut-offs (21.3, 1.23 ng/ml, 32.8 mg/L) achieved AUCs of 0.80, 0.84, and 0.60, respectively. Combined MDW/PCT detection achieved an AUC of 0.90 with 88.2% sensitivity and 88.7% specificity.

Conclusion: MDW, especially when combined with PCT, improves diagnostic accuracy for neonatal sepsis management.

Background: Chronic pulmonary abscess usually results from bacterial or mycobacterium infection, but rarely from aspergillosis. Chronic pulmonary aspergillosis is usually found in a person with structural lung disease or immunocompromise. Here, we report a case of chronic lung abscess of aspergillosis without immunocompromise, structural lung diseases or even clinical symptoms.

Case presentation: A 43-year-old female was found a mass shadow with central liquid anechoic area in the apical posterior segment of the left upper lung lobe by chest computerized tomography for 1 month, but had no any systematic or respiratory complaints. The percutaneous abscess puncture was performed and 30 milliliters of yellow purulent fluid were aspirated from the liquid anechoic area. Then Aspergillus terreus was detected by both fluid culture and metagenomics next-generation sequencing. Interestingly, this patient had no history of tuberculosis or chronic pulmonary diseases. Other immunocompromised conditions were also denied through history inquest and laboratory tests. Ultimately, the catheterization and drainage of the lung abscess and 6 months of antifungal therapy with standard dose of voriconazole brought the woman a favorable outcome.

Conclusion: Aspergillus lung abscess can occasionally occur in a person without pre-existent lung cavity and immune suppression, which is prone to misdiagnosis because of the rarity and the symptom-free.

Background: Point of need diagnostics provide efficient testing capability for remote or austere locations, decreasing the time to answer by minimizing travel or sample transport requirements. Loop-mediated isothermal amplification (LAMP) is an appealing technology for point-of-need diagnostics due to its rapid analysis time and minimal instrumentation requirements.

Methods: Here, we designed and optimized nine LAMP assays that are sensitive and specific to targeted bacterial select agents including Bacillus anthracis, Francisella tularensis, Yersinia pestis, and Brucella spp. Evaluation of each assay determined preliminary limit of detection (LOD) with LOD confirmed across 60 replicates (≥ 95% positivity rate). Testing across a robust set of strains of the target agent, common DNA agents, and near-neighbors documented sensitivity and specificity for independent assays.

Results: Specifically, all assays were 100% specific and sensitive except for Y. pestis Caf1 (90% inclusive across Y. pestis strains).

Conclusion: Here, we optimized assay turn-around-time, decreasing a standard 60 min traditional polymerase chain reaction (PCR) to 30 min using LAMP with positive results in as little as 5-10 min. Incorporating point of need sample processing and evaluating the potential inhibitory impact of sample matrices such as whole blood and soil would be needed to enable this test system for use on field-forward clinical and environmental sample testing.

Background: Diabetes and malignant tumors often lead to abnormal immune function, increasing susceptibility to herpes zoster and severe post-herpetic neuralgia. Renal insufficiency following renal cell carcinoma surgery can be compounded by treatment with nephrotoxic antiviral drugs. There have also been case reports of herpes zoster occurring at the surgical site.

Case presentation: A 68-year-old man developed herpes zoster at the surgical site and severe neuralgia following left nephroureterectomy for left kidney clear cell carcinoma accompanied by postoperative renal insufficiency. After treatment with brivudine, the herpes was controlled, and neuralgia began to subside by day 3, with crust formation occurring by day 9.

Conclusions: Postoperative nerve injury and regeneration may influence varicella-zoster virus latency. This case indicates that brivudine is an effective treatment for herpes zoster in patients with chronic renal insufficiency.

Background: Hepatitis A remains a public health concern, particularly in areas with suboptimal sanitation. Introduced in Turkey's immunization schedule in 2011, the vaccine has improved immunity; however, gaps persist, especially in older, unvaccinated children. This study examines the seropositivity rates and antibody levels in children across different vaccination statuses and age groups, and to identify gaps in immunity, particularly among children those born before the introduction of the hepatitis A vaccine in Turkey.

Methods: Data from 9,858 patients, collected between August 2019 and March 2024, were analyzed to evaluate the immunological response to the vaccine. Patients were categorized into four groups based on vaccination status: under-vaccinated (children 6-18 months old), single-dose vaccinated (children 18-24 months old), fully vaccinated (children over 24 months old born after March 1, 2011), and unvaccinated (born before March 1, 2011, when routine hepatitis A vaccination began). Seropositivity rates and antibody levels were measured and statistically analyzed.

Results: In this study, a total of 9,858 pediatric patients were assessed, with 1.1% under-vaccinated, 3.4% single-dose vaccinated, 60.5% fully vaccinated, and 35% unvaccinated. Seropositivity rates reached 93% in the fully vaccinated group, compared to 83% in the single-dose group and 63% in the unvaccinated group. Antibody titers were significantly higher in the fully vaccinated group, with statistically significant differences in seropositivity between this group and the unvaccinated group (p < 0.001). Additionally, a notable decrease in antibody levels was observed in the unvaccinated group as age increased (r = -0.365, p < 0.001).

Conclusion: These findings underscore the critical need for targeted interventions to close vaccination gaps, especially among older, unvaccinated children who exhibit lower immunity levels. These insights are crucial for enhancing vaccination outreach and improving public health measures against hepatitis A.