BMC Infectious Diseases最新文献

Background: Macroamylasemia is a rare condition affecting 0.5-1.5% of the population. Macroamylasemia should be suspected in a patient with a high serum alpha-amylase level without an elevation in the urine alpha-amylase level. Serum amylase binds with other serum proteins like immunoglobulins A (92%), immunoglobulins G (< 30%), and others (< 5%), forming macromolecular complexes that weigh more than 400 KDa. Nephrones are unable to secrete these macromolecules into the urine due to their large size, which causes the accumulation of these macromolecules in the serum. Patients with COVID-19 during seroconversion develop higher concentrations of SARS-CoV-2-specific immunoglobulins and different plasma proteins, which can bind with the alpha amylase molecules and cause macroamylasemia.

Case presentation: In this case report, we report about a 70-year-old hypertensive and asthmatic patient who was under inward treatment for mild COVID-19. He complained ofburning epigastric pain for  one day and his elevated serum amylase level persisted months after the initial presentation. He underwent extensive investigations to exclude acute pancreatitis and other causes of high amylase levels. His amylase creatinine clearance ratio was 0.2%, his pre- polyethylene glycol(PEG) amylase concentration was 644 U/L, and his post-PEG amylase concentration was 10 U/L with a very low post-PEG recovery (1.55%). He was diagnosed with macroamylasemia.

Background: Fungal pathogens are ubiquitous microorganisms that are implicated in a wide range of infections, affecting individuals with underlying health conditions and immune suppression therapy; however, immunocompetent individuals may also be at risk. Among these infections, many are caused by molds and yeasts other than Candida and are recognized in clinical practice, such as aspergillosis, mucormycosis, fusariosis, phaeohyphomycosis, and basidiobolomycosis, among others, each presents different clinical manifestations and requires clinical management specific to the site of involvement. Although pathogenic fungal contaminants and potential sources of mycosis in humans are plentiful in Gulf Cooperation Council (GCC) countries, epidemiological reports regarding mycosis in the region are scarce.

Aim: The aim of this review is to shed some light on the epidemiology of clinically associated molds and yeasts other than Candida and to survey all related case reports and epidemiological studies conducted in the GCC over the past 10 years.

Methods: A comprehensive search of the Medline (PubMed) and Scopus databases was conducted using the following keywords: Aspergillosis, Mycosis, Mucormycosis, Fusarium, Kuwait, Bahrain, Saudi Arabia, Qatar, Oman and the United Arab Emirates. A timeframe was set to include only articles that were published from 2014 to 2024.

Results: One hundred thirty-five of the 1563 articles examined fulfilled the purpose of this review. Most studies were in Saudi Arabia (45%), Qatar (18%) and Kuwait (16%). Mucormycosis, aspergillosis, phaeohyphomycosis and basidiobolomycosis were among the most commonly reported fungal infections in the GCC, with corresponding mortality rates of 53%, 37%, 69% and 24%, respectively. The average estimations of non-Candida fungal infections indicate a low regional incidence in comparison with global estimations.

Conclusion: Awareness and a high index of suspicion are warranted in successfully managing non-Candida mycosis. More specific immunological and molecular markers are needed for differential diagnosis to rule out fungal infections. Additionally, incorporating non-Candida mycosis-related antifungal resistance surveys in GCC national surveillance efforts should be enforced, especially when considering the increase in global mycosis rates.

Introduction: Uganda has made significant progress in expanding access to ART over the years, however, currently up to 50% of People Living with HIV still enroll into HIV care with Advanced HIV Disease (AHD). This study therefore seeks to evaluate the screening, diagnosis and treatment of AHD at a high volume not for profit health facility in an urban setting in Southwestern Uganda.

Methods: A cross-sectional study utilizing secondary data from a high volume, nonprofit health facility in southwestern Uganda was conducted from April 2022 to August 2022. The analysis included patient records for 994 newly diagnosed individuals and 76 patients who were not virologically suppressed. A descriptive analysis of the data was conducted, and the two groups (newly diagnosed and non-suppressed) were compared using chi-square tests or Fisher's exact test for categorical data, as well as the Mann Whitney U test for numerical data.

Results: The prevalence of AHD as defined by a CD4 + cell count below 200 cells/mm³ or WHO clinical stage 3 or 4 disease was 21.7% (216/994). The prevalence of AHD was considerably higher among males (32.5%) compared to females (13.9%) (p value < 0.001). CD4 + testing for AHD was at 74.5% (741/994) among newly enrolled patients compared to 77.6% (59/76) among virally non suppressed patients (p = 0.822). Serum CrAg testing among patients with AHD was higher among the newly enrolled HIV clients at 60.6% (131/216) compared to non-suppressed clients; 22.2% (6/27) (p < 0.001). Additionally, there was no significant difference in administration of fluconazole between the two groups (p = 0.476). Among the patients with AHD, the proportion of patient tested for TB using urine TB_LAM was higher among the newly enrolled patients (45.9%) compared to the non-suppressed clients (21.4%), and this difference was statistically significant (p = 0.010).

Conclusion: This study demonstrates that the prevalence of AHD remains high, and the implementation of the AHD intervention package remains sub-optimal. The Ministry of Health and partners need to strengthen implementation strategies to improve the screening, diagnosis, and management of AHD.

Background: Acute respiratory tract infections are very common and can be caused by many pathogens. The aim of this study was to understand the characteristics of multi-pathogen infections of respiratory tract infections during the seasonal changes in winter and spring in Xinjiang.

Methods: Throat swab samples were collected from 2791 patients with influenza-like illness (ILI) and hospitalized severe acute respiratory tract infection (SARI) in Xinjiang from January 2024 to May 2024 for multi-pathogen detection. Then, the infection frequency of pathogens and their distribution characteristics in different months, genders, regions and case classifications were analyzed.

Results: The positive infection rate of pathogens in 2791 patients was 48.30% (1348/2791). The proportion of patients infected with respiratory pathogens in the 0-9 age group was the highest. Of all pathogens detected, MP was most common in positive patients (22.03%). The highest frequency of multiple infections was SPn. RSV, FluA and FluB were the main infectious pathogens in January and February. The number of RV, HPIV and MP infections showed an increasing trend from January to May. Compared to female patients, male patients are more likely to be infected with ADV and SPn. Compared with hospitalized SARI patients, outpatient and emergency ILI patients were more susceptible to infection with ADV and FluB. However, hospitalized SARI patients were more susceptible to infection with RSV and MP. The positive infected patients mainly came from northern Xinjiang (60.83%). Compared with other regions, the proportion of ADV positive patients in northern Xinjiang was higher.

Conclusion: This study revealed the distribution characteristics of pathogen infection in patients with respiratory tract infections in different months, genders, regions and case classifications during the seasonal changes of winter and spring in Xinjiang for the first time, which is helpful to formulate more effective treatment strategies and preventive measures.

Clinical trial number: not applicable.

Capnocytophaga ochracea (C. ochracea) is a species of Gram-negative and facultative anaerobic bacterium. It was first reported in 1979 and isolated from both healthy and diseased sites in the oral flora. The bacteria can cause septicemia, endocarditis, endometritis, blepharoconjunctivitis and other infections. Herein, we present the first cerebrospinal fluid (CSF) infection case caused by C. ochracea in humans. Gram-negative fusiform, non-spore forming rods were detected in an anaerobic bottle of CSF culture obtained from a 50-year-old man who had been hospitalized for meningioma in Tianjin Huanhu Hospital. Although the organism could not be identified using a conventional method, it was finally identified as C. ochracea based on the results of metagenomics next generation sequencing, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and 16 S rDNA sequencing analysis. Subsequently, Streptococcus oralis was also detected in the CSF of the patient. The patient was treated with meropenem and vancomycin, and the infection was well controlled. The clinically rare C. ochracea can be pathogenic in central nervous system of humans.

Background: Catheter-associated urinary tract infections (CAUTIs) are one of the most common types of healthcare-associated infections (HAIs). Current studies mainly focus on risk factors, but the method to control them is unresolved. We aim to give an overview of the epidemiology of CAUTIs and explore the effects of bundle intervention on intensive care unit (ICU) inpatients.

Methods: A multi-center, double-blind, retrospective study was conducted in eight Xiamen medical centers over six months; we recruited ICU inpatients with indwelling urinary catheters (UC) > = 48 h. Data were analyzed using Chi-Square and student's t-test.

Results: With bundle interventions, the CAUTI rate in ICUs decreased from 3.84 to 1.31 per 1000 UC days. The UC utilization was significantly reduced after bundles (71.29-62.70%), and the average duration of indwelling UC was reduced considerably (7,035 days vs. 6,884 days). CAUTIs in patients over 60 years old were significantly reduced after bundles. There were 45 causative organisms detected from 36 cases of CAUTIs, including 12 multidrug-resistant bacteria.

Conclusions: Bundles have been shown to reduce the risk of CAUTIs in patients with indwelling catheters in the ICU, especially older adults. It also significantly reduces the use of Carbapenem. Therefore, CAUTI bundles are recommended to clinicians.

Background: Serum phosphate levels have been reported to be linked to the prognosis in critically ill patients. The purpose of this study was to analyze the impact of the trajectory of changes in serum phosphate levels on the short-term mortality risk in patients with sepsis.

Methods: This retrospective cohort study used data on patients with sepsis from the 2008-2019 Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Serum phosphate level trajectories were constructed using a latent growth mixture modeling (LGMM) based on four measurements of serum phosphate at six-hour intervals within 24 h of admission to the intensive care unit (ICU). The relationship between serum phosphate levels at ICU admission and serum phosphate level trajectories and the risk of 28-day mortality in patients with sepsis was analyzed using Cox regression models, and hazard ratio (HR) and 95% confidence interval (CI) were calculated.

Results: Of these 1,703 patients with sepsis included, 566 (33.24%) died within 28 days. The median serum phosphate levels of the patients were 4.10 (3.00, 5.50) mg/dL. Four serum phosphate level trajectories were classified: normal-level-steady trend (trajectory 1), high-level-steady trend (trajectory 2), high-level-decreasing trend (trajectory 3), and high-level-increasing trend (trajectory 4). High serum phosphate levels at admission were associated with a higher risk of 28-day mortality (HR = 1.05, 95%CI: 1.01-1.09) in patients with sepsis. For trajectories, trajectory 2 (HR = 1.27, 95%CI: 1.05-1.54) related to an increased risk of 28-day mortality compared with trajectory 1, whereas trajectory 4 (HR = 1.69, 95%CI: 0.99-2.91, P = 0.056) may be related. There was no significant difference in 28-day mortality between patients on trajectory 3 and trajectory 1 (P = 0.280). Subgroup analyses demonstrated that patients with trajectory 2 were linked to a higher risk of 28-day mortality in different population subgroups (P < 0.05).

Conclusion: Stable trajectories of high serum phosphate levels are an important risk factor for short-term mortality in patients with sepsis.