BMC Infectious Diseases最新文献

Objectives: Disruptive public health risks and events, including infectious disease outbreaks, are inevitable, but their effects can be mitigated by investing in prevention and preparedness. We assessed the epidemic preparedness and response capacities of health systems in 186 countries from 2018 to 2022.

Methods: We utilized data from the International Health Regulations (IHR) State Party Self-Assessment Annual Reporting (SPAR) submissions to assess health systems' IHR capacities to (1) prevent, (2) detect, (3) respond, (4) enable resources and coordinate, and (5) ensure operational readiness from 2018 to 2022. We categorized the IHR capacities into five levels, with level 1 denoting the lowest level of national capacity and level 5 the highest. We calculated each index's capacity level as the arithmetic mean of its related indicators and analyzed changes over time using the Mann-Kendall nonparametric trend test.

Results: SPAR reporting marginally improved from 92.9% (182 of 196 countries) in 2018 to 94.9% (186 of 196 countries) in 2022, with considerable improvement in all five capacity domains over this period: prevention (58.4 in 2018 to 66.5 in 2022), detection (74.7 to 78.3), response (56.5 to 67.8), enabling resources and coordination (63.0 to 68.3), and ensuring operational readiness (62.8 to 69.9). From the 2022 submissions, 116 (62%) countries reported functional (Level 4 or 5) prevention capacity, 162 (87%) had functional detection capacity, 118 (63%) had functional response capacity, 121 (65%) had functional enabling resources and coordination capacity, and 133 (72%) had functional operational readiness against public health events. Across all the indexes, the WHO African Region reported the fewest countries with functional capacity in these domains.

Conclusions: There was an overall increase in functional capacity across all five domains at both global and regional levels; and a high percentage of countries achieved functional capacity across all domains in 2022. However, a significant number of countries, particularly in the Global South, have yet to achieve functional competence in these capacities, leaving the world vulnerable to the persistent risk of epidemics and infectious biohazards. Strengthening IHR competencies through local, national, and global engagements must be urgently prioritized to achieve global health security against infectious diseases.

Background: In May 2024, a chickenpox outbreak was reported at Xiasha Primary School located in Nanshan District, Shenzhen City, China, with a total of 12 cases identified. Despite thorough on-site investigations, the source of infection remained undetected. The purpose of our study was to infer the timing and duration of the infectious period of the initial case using modeling techniques, thereby deducing the identity of the source.

Methods: We conducted an individual contact survey within the class affected by the epidemic and utilized an agent-based model (ABM) to estimate the key parameters related to the timing of the infectious source's emergence and the duration of its infectiousness. The point estimates derived from the ABM served as prior information for a subsequent Bayesian analysis, which in turn provided the posterior distribution for these parameters.

Results: Our models suggested the infection source entered the classroom around April 24th (95% credible interval: April 22nd to April 26th), with an infectious period of approximately two days. Based on these findings, we should aim to detect students who may have been absent due to atypical chickenpox symptoms during this period and closely examine teachers who were present for two consecutive days for any indication of potential infection.

Conclusion: This study demonstrates the efficacy of combining contact surveys with mathematical modeling for outbreak source tracing, offering a novel approach to supplement field epidemiological surveys.

Clinical trial number: Not applicable.

There is clearly a need for novel antifungal agents, not only concerning spectrum, but also oral bioavailability, tolerability, and drug-drug interactions. There is growing concern for antifungal resistance for current available antifungals, mainly driven by environmental fungicide use or long-term exposure to antifungals, in the setting of mould-active prophylaxis or for chronic antifungal infections, such as chronic pulmonary aspergillosis. Moreover, the incidence of breakthrough infections is increasing, because of the introduction of (mould-active) prophylaxis (1-4). There is emergence of difficult to treat invasive fungal infections, such as those caused by Lomentospora prolificans, cryptic species of Aspergillus, Scedosporium and Coccidioides. Olorofim (F901318) is the first-in class of the orotomides, a novel antifungal class targeting dihydroorotate dehydrogenase (DHODH), a key enzyme in the biosynthesis of pyrimidines. Olorofim shows good in vitro and in vivo activity against Aspergillus species, rare and difficult to treat moulds and endemic dimorphic fungi, including azole- and amphotericin-resistant isolates. It lacks activity against yeasts and the Mucorales species. It is only orally available and shows very promising results in ongoing clinical trials. In this review we will describe the mechanism of action of olorofim, the spectrum of activity in vitro and in vivo, pharmacokinetics, pharmacodynamics, drug-drug interactions, resistance, and clinical outcomes.

Objectives: Tuberculosis (TB) presents a substantial danger to populations experiencing crises like earthquakes. This study aims to explore the effect of the Kermanshah earthquake on the trend of TB.

Methods: This cross-sectional study examined tuberculosis data from 2009 to 2020, using monthly diagnoses. Data was collected from the TB research office and registration system. The study employed interrupted time series (ITS) analysis to assess both the immediate and long-term impacts of the earthquake on TB cases.

Results: In Sarpol-e Zahab, TB cases initially surged after the earthquake, indicating an immediate effect, but then significantly declined compared to pre-earthquake levels, reflecting an effect over time (β₀ = 1.39, β₁=-0.004, β₂ = 0.11 and β₃=-0.01, P = 0.001 and Post-intervention linear trend= -0.015, P < 0.001). In Ghasr-e Shirin, the average number of TB cases prior to the earthquake was estimated at 0.58 cases, with a significant monthly decrease of 0.005 cases leading up to the earthquake (P = 0.001). There was no significant immediate change in TB cases during the first month after the earthquake (β₂ = 0.008, P = 0.680). Post-earthquake, TB cases dramatically increased (β₃ = 0.008, P = 0.001). The monthly trend of TB cases rose significantly by 0.002 (P = 0.001), indicating an effect over time. In Salas-e Babajani, there was no immediate change in TB cases, but there was a significant long-term decline compared to the period before the earthquake (P = 0.001).

Conclusions: Earthquake is one of the natural crises that provide the conditions for the increase of TB. Local health policymakers must make plans in these areas to contain TB after the earthquake.

Background: Typhoid fever remains a significant public health problem contributing to significant misapplication of antibiotics in Ghana. However, there is little data on the accuracy of the commonly used serology based rapid diagnostic Typhidot test kit (Typhidot RDT) for confirming typhoid fever.

Methods: We conducted a study to assess the diagnostic accuracy of Typhidot RDT in seven clinical facilities across five regions in Southern Ghana. A total of 258 participants, clinically diagnosed with typhoid fever, were enrolled in this study. Blood and stool samples were obtained for culture, Typhidot and PCR assays. Disc diffusion antibiotic sensitivity was performed to determine the resistance pattern of Salmonella enterica isolates from positive blood and stool cultures.

Results: Recovery of S. enterica isolates was higher from stool samples (14.7%) in comparison to blood samples (1.6%). The sensitivity and specificity of Typhidot compared to blood and stool cultures was 35% (19.94%-52.65%) and 45% (38.67%-51.45%), respectively. Compared to PCR, the Typhidot had a sensitivity and a specificity of 61% and 53%, respectively. Resistance phenotyping of isolates showed broad sensitivity to the front-line antibiotics used. Resistance to ampicillin (10%), cotrimoxazole (7%), azithromycin and ciprofloxacin (< 5%) was found in some isolates.

Conclusions: These findings suggest sub-optimal performance of the Typhidot RDT for diagnosis of typhoid in Ghana with a higher chance for misdiagnosis and misapplication of antibiotics. The high proportion of isolates recovered from stool culture is consistent with the pathophysiology of bacterial shedding during the acute phase of infection, which provides a window of opportunity to control typhoid transmission.

N. neocaledoniensis is a very rare infectious pathogen that causes human disease, particularly in immunocompromised individuals. In this case report, we describe the successful diagnosis of N. neocaledoniensis in a patient confirmed by mNGS and the treatment of multiple skin abscesses due to N. neocaledoniensis infection. mNGS is an important diagnostic method complementary to routine bacterial culture and identification methods, especially for rare, novel, co-infected pathogens, and pathogens that are difficult to culture. This report may provide a reference for the clinical treatment and diagnosis of N. neocaledoniensis infection in humans.

Herpes Simplex Virus-1 (HSV-1) Kaposi varicelliform eruption (KVE) is a rare and severe cutaneous manifestation, clinically characterized by the presence of widespread vesicles and pustules. A case report details a patient with a history of Atopic Dermatitis (AD) and recent SARS-CoV-2 infection who developed a severe KVE subsequent to the viral illness. The patient, a 35-year-old male, presented with severe atopic dermatitis (AD) subsequent to a SARS-CoV-2 infection. In a period of four months, the dermatological eruption underwent a rapid progression to a severe state, characterised by the presence of extensive vesicles and pustules, in addition to the emergence of symptoms. In conjunction with a chest CT scan, plasma and antigen testing, the patient was confirmed to be positive for HSV-1 positive. The patient exhibited elevated levels of IgE and a notable reduction in the absolute number of immune cells. The patient was treated with valaciclovir, piperacillin-tazobactam, IVIG at the same time. Within seven days of treatment, the blisters had dried up and the scabs had fallen off without any pain, pruritus, or fever. This case highlights the potential for severe viral eruptions, such as KVE in individuals with underlying dermatological conditions following viral infections.

Background: Emerging research indicates the potential for early transition from intravenous to oral antimicrobial therapy in certain infections. This trend may have implications for outpatient parenteral antibiotic therapy (OPAT) programs, as the demand for prolonged intravenous treatment could decrease. The objective of this study was to evaluate the frequency and evolution of OPAT courses of ≥ 14 days over the years and determine the medical justification for those prolonged treatments.

Methods: All patients treated intravenously for ≥ 14 days by the OPAT program at Lausanne University Hospital, Switzerland, between 2017 and 2022 were included in the study. Data were extracted from a prospectively established OPAT database. Prevalence of prolonged antibiotic treatment and its clinical and microbiological information were identified.

Results: During the study period, a total of 2,448 treatment courses were administered: 1,636 intravenous (IV) and 812 oral treatments. Of the IV treatments courses, 749 (36%) were of a duration of ≥ 14 days, without discernible trend over the 6-year study period. The most common type of infections needing prolonged treatment were bone and joint infections (31%), endovascular infections (18%), complicated intra-abdominal infections (15%), and urinary tract infections (11%), with only minor fluctuations in these proportions during the study period. Finally, the use of second-line antibiotics (piperacillin-tazobactam, carbapenems and vancomycin) did not increase over the years, suggesting that prolonged intravenous antibiotic therapy is not linked to an increase of anti-microbial resistance in our cohort.

Conclusions: Despite the general trend towards shorter intravenous treatment courses in infectious diseases, our OPAT unit did not observe a decline in the use of prolonged intravenous antibiotic therapy between 2017 and 2022, suggesting that OPAT units will probably not see a decrease in their activities in the near future.