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Global landscape of vancomycin-resistant enterococci in hematopoietic stem-cell transplantation patients: a systematic review and meta-analysis. 造血干细胞移植患者中耐药万古霉素肠球菌的全球分布情况:系统回顾和荟萃分析。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-22 DOI: 10.1186/s12879-024-10100-0
Seyed Pooria Tadayon Nabavi, Mohsen Chamanara, Arasb Dabbagh Moghaddam, Mahdi Ghorbani, Reza Heidari, Mehdi Shakouri Khomartash, Javad Behroozi, Farhad Motavalli, Ali Shakerimoghaddam

Background: One of the main risks of infection after hematopoietic stem cell transplantation (HSCT) is infection by gram-positive bacteria, including vancomycin-resistant enterococci (VRE). Based on the format of a global review and meta-analysis study, this study aims to investigate the incidence of VRE bloodstream infection (BSI) after HSCT in colonized individuals.

Methods: The keywords of the systematic search included vancomycin-resistant enterococci and HSCT. These words were searched in Google Scholar, PubMed/Medline, Scopus, and Web of Science databases from January 1, 2000, to March 1, 2024. Studies that reported the prevalence of vancomycin-resistant enterococci in patients undergoing HSCT were included. The random effects model was used for the meta-analyses. Investigations were conducted according to PRISMA guidelines, and the protocol was registered in PROSPERO: CRD42024543491.

Results: Out of 1100 screened papers, 28 were eligible. The random effects model was established to analyze the incidence of VRE BSI after HSCT. The pooled prevalence of co-infection for Allo-HSCT recipients was 3.023 (95% CI, Z-value = -3.5, p-value < 0.0001), and this value for Auto-HSCT recipients was 11.89 (95% CI, Z-value = -2.923, p-value < 0.001). These results showed that the rate of BSI due to vancomycin-resistant enterococcus in Auto-HSCT recipients is higher than Allo-HSCT.

Conclusions: The prevalence of vancomycin-resistant enterococci in Auto-HSCT recipients is higher than that of Allo-HSCT, possibly due to colonization of the intestines of these people with vancomycin-resistant enterococci before transplantation. VRE Colonization before transplantation increases the likelihood of post-transplant VRE BSI and other bacterial infections, including Gram-negative. The strains should be analyzed by sequencing before and after HSCT for a more detailed investigation.

背景:造血干细胞移植(HSCT)后感染的主要风险之一是革兰氏阳性菌感染,包括耐万古霉素肠球菌(VRE)。本研究以全球综述和荟萃分析研究的形式为基础,旨在调查造血干细胞移植后定植者VRE血流感染(BSI)的发生率:系统检索的关键词包括耐万古霉素肠球菌和造血干细胞移植。从 2000 年 1 月 1 日至 2024 年 3 月 1 日,在 Google Scholar、PubMed/Medline、Scopus 和 Web of Science 数据库中对这些关键词进行了检索。纳入了报告造血干细胞移植患者耐万古霉素肠球菌流行率的研究。荟萃分析采用随机效应模型。研究按照PRISMA指南进行,研究方案在PROSPERO中注册:CRD42024543491:在 1100 篇筛选论文中,28 篇符合条件。建立随机效应模型分析造血干细胞移植后 VRE BSI 的发生率。Alo-HSCT受者合并感染的汇总流行率为3.023(95% CI,Z值=-3.5,P值 结论:万古霉素耐药造血干细胞感染的流行率为3.023(95% CI,Z值=-3.5,P值):耐万古霉素肠球菌在自体-HSCT 受者中的流行率高于异体-HSCT 受者,这可能是由于耐万古霉素肠球菌在这些人的肠道中定植于移植前所致。移植前的 VRE 定植会增加移植后 VRE BSI 和其他细菌感染(包括革兰氏阴性菌)的可能性。应在造血干细胞移植前后对菌株进行测序分析,以便进行更详细的调查。
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引用次数: 0
Clinical analysis of 20 cases of perinatal tuberculosis. 对 20 例围产期结核病的临床分析。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-22 DOI: 10.1186/s12879-024-09989-4
Ying Zhu, Houxi Bai, Mingbo Zhao, Xiaotao Yang, Yi Huang, Lu Xu, Haifeng Jin, Houyu Chen, Penghao Cui, Yonghan Luo

Background: To analyze the clinical manifestations, diagnostic and therapeutic processes of perinatal tuberculosis in children, providing reference for clinicians in the diagnosis and treatment of this disease.

Methods: A retrospective analysis was conducted on the epidemiological history, clinical manifestations, laboratory and imaging findings, and treatment follow-up of 20 cases of perinatal tuberculosis diagnosed in the Second Department of Infectious Disease, Kunming Children's Hospital, from February 2014 to September 2021.

Results: Of the 20 cases, 13 were male (65.0%) and 7 were female (35.0%). The average age at onset was 35.35 ± 23.03days, with an average time from onset to diagnosis of 24.75 ± 15.55days. Tuberculin skin test (TST) was positive in 1 out of 4 cases (25.0%). Gamma interferon release assays (IGRAs) were positive in 9 out of 17 cases (52.9%).acid-fast staining was positive in 7 out of 16 cases (43.7%), and Mycobacterium tuberculosis nucleic acid polymerase-chain-reaction(PCR) was positive in 14 out of 20 cases (70.0%). Chest CT showed miliary changes in 4 out of 19 cases (21.0%), multiple nodular and patchy opacities in 6 out of 19 cases (31.6%), and pulmonary consolidation and atelectasis in 10 out of 19 cases (52.6%). After anti-tuberculosis treatment, 16 out of 20 cases (80.0%) improved, and no recurrence of tuberculosis was observed during follow-up periods ranging from 9 months to 3 years. The growth and development of these children were similar to those of healthy children.

Conclusion: The clinical manifestations and chest imaging features of perinatal tuberculosis are nonspecific. In suspected cases, it is crucial to investigate the mother's condition thoroughly and complete etiological examinations to achieve early diagnosis and timely treatment, which can improve prognosis.

背景:分析儿童围产期结核病的临床表现、诊断和治疗过程,为临床诊断和治疗该病提供参考:目的:分析儿童围产期肺结核的临床表现、诊断和治疗过程,为临床医生诊断和治疗该病提供参考:对昆明市儿童医院感染二科2014年2月至2021年9月确诊的20例围生期肺结核患者的流行病学史、临床表现、实验室和影像学检查结果及治疗随访情况进行回顾性分析:20例患者中,男性13例(65.0%),女性7例(35.0%)。平均发病年龄为(35.35±23.03)天,从发病到确诊的平均时间为(24.75±15.55)天。4 例中有 1 例(25.0%)结核菌素皮肤试验(TST)呈阳性。γ干扰素释放检测(IGRA)在17例中有9例(52.9%)呈阳性,耐酸染色在16例中有7例(43.7%)呈阳性,结核分枝杆菌核酸聚合酶链反应(PCR)在20例中有14例(70.0%)呈阳性。胸部 CT 显示,19 例中有 4 例(21.0%)出现粟粒状改变,6 例(31.6%)出现多发结节状和斑片状不透明,10 例(52.6%)出现肺部合并症和肺不张。经过抗结核治疗后,20 例病例中有 16 例(80.0%)病情好转,在 9 个月至 3 年的随访期间未发现结核病复发。这些儿童的生长发育与健康儿童相似:结论:围产期结核病的临床表现和胸部影像学特征是非特异性的。结论:围产期肺结核的临床表现和胸部影像学特征是非特异性的,对于可疑病例,关键是要彻底调查母亲的病情并完成病原学检查,以实现早期诊断和及时治疗,从而改善预后。
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引用次数: 0
Genomic dynamics of high-risk carbapenem-resistant klebsiella pneumoniae clones carrying hypervirulence determinants in Egyptian clinical settings. 埃及临床环境中高风险耐碳青霉烯类肺炎克雷伯菌克隆携带高毒决定簇的基因组动态。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-22 DOI: 10.1186/s12879-024-10056-1
Nehal Adel Abdelsalam, Shahira A ElBanna, Shaimaa F Mouftah, José F Cobo-Díaz, Ahmed H Shata, Sherine M Shawky, Reham Atteya, Mohamed Elhadidy

Background: Ongoing studies have revealed the global prevalence of severe infections caused by the hypervirulent strains of Klebsiella pneumoniae (K. pneumoniae). Meanwhile, the World Health Organization and the Centers for Disease Control declared carbapenem-resistant K. pneumoniae as an urgent public health threat, requiring swift and effective action to mitigate its spread. Low- and middle-income countries are severely impacted by such devastating infectious diseases owing to the ill implementation of antimicrobial practices and infection control policies. Having both hypervirulence and carbapenemase gene determinants, the emergence of convergent hypervirulent carbapenem-resistant K. pneumoniae is now being reported worldwide.

Methods: In this study, we sequenced 19 carbapenemase-producing K. pneumoniae strains recovered from various clinical specimens. Additionally, we evaluated the phenotypic antimicrobial susceptibility to multiple antimicrobial classes using the VITEK2 automated system. Utilizing the sequencing data, we characterized the sequence types, serotypes, pangenome, resistance profiles, virulence profiles, and mobile genetic elements of the examined isolates. We highlighted the emergence of high-risk clones carrying hypervirulence genetic determinants among the screened isolates.

Results: Our findings revealed that all carbapenem-resistant isolates exhibited either extensive- or pan-drug resistance and harbored multiple variants of resistance genes spanning nearly all the antimicrobial classes. The most prevalent carbapenemase genes detected within the isolates were blaNDM-5 and blaOXA-48. We identified high-risk clones, such as ST383-K30, ST147-K64, ST11-K15, and ST14-K2, which may have evolved into putative convergent strains by acquiring the full set of hypervirulence-associated genetic determinants (iucABCD, rmpA and/ or rmpA2, putative transporter peg-344). Additionally, this study identified ST709-K9 as a high-risk clone for the first time and uncovered that capsule types K15 and K9 carried hypervirulence genetic determinants. The most frequent Inc types found in these isolates were Col440I, IncHI1B, and Inc FII(K).

Conclusion: This study highlights the emergence of high-risk, extensively carbapenem-resistant K. pneumoniae strains co-carrying hypervirulence determinants in Egyptian clinical settings. This poses an imminent threat not only to Egypt but also to the global community, underscoring the urgent need for enhanced surveillance and control strategies to combat this pathogen.

背景:正在进行的研究显示,肺炎克雷伯氏菌(K. pneumoniae)的高毒力菌株引起的严重感染在全球普遍存在。与此同时,世界卫生组织和美国疾病控制中心宣布耐碳青霉烯类抗生素肺炎克雷伯菌是一个紧迫的公共卫生威胁,需要采取迅速有效的行动来减少其传播。由于抗菌措施和感染控制政策执行不力,中低收入国家受到这种毁灭性传染病的严重影响。肺炎克雷伯菌同时具有高黏菌丝和碳青霉烯酶基因决定因子,目前全球范围内都有关于出现高黏菌丝耐碳青霉烯类肺炎克雷伯菌的报道:在本研究中,我们对从各种临床标本中回收的 19 株产碳青霉烯酶肺炎克氏菌进行了测序。此外,我们还使用 VITEK2 自动系统评估了表型对多种抗菌药物的敏感性。利用测序数据,我们确定了受检分离株的序列类型、血清型、泛基因组、耐药性特征、毒力特征和移动遗传因子。我们强调了筛选出的分离物中出现的携带高致病力基因决定簇的高风险克隆:结果:我们的研究结果表明,所有耐碳青霉烯类的分离株都表现出广泛耐药或泛耐药,并携带多种耐药基因变体,几乎涵盖了所有抗菌药物类别。在分离株中检测到的最普遍的碳青霉烯酶基因是 blaNDM-5 和 blaOXA-48。我们发现了 ST383-K30、ST147-K64、ST11-K15 和 ST14-K2 等高风险克隆,它们可能是通过获得全套高繁殖力相关遗传决定因子(iucABCD、rmpA 和/或 rmpA2、假定转运体 peg-344)而进化成假定融合菌株的。此外,这项研究还首次将 ST709-K9 鉴定为高风险克隆,并发现 K15 和 K9 胶囊型携带高致病性基因决定簇。在这些分离株中发现的最常见的Inc类型是Col440I、IncHI1B和Inc FII(K):本研究强调了埃及临床环境中出现的高风险、广泛耐碳青霉烯类的肺炎克氏菌菌株同时携带高致病力基因决定簇。这不仅对埃及,也对全球社会构成了迫在眉睫的威胁,凸显了加强监测和控制策略以对抗这种病原体的迫切需要。
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引用次数: 0
Correction: Antimicrobial Sub-MIC induces Staphylococcus aureus biofilm formation without affecting the bacterial count. 更正:抗菌剂 Sub-MIC 可诱导金黄色葡萄球菌形成生物膜,但不会影响细菌数量。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-22 DOI: 10.1186/s12879-024-10038-3
Raghda Elawady, Aliaa G Aboulela, Ahmed Gaballah, Abeer A Ghazal, Ahmed N Amer
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引用次数: 0
Epidemiological characteristics of influenza outbreaks in schools in Jiangsu Province, China, 2020-2023 post-COVID-19 pandemic. COVID-19 大流行后 2020-2023 年江苏省学校流感暴发的流行病学特征。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-22 DOI: 10.1186/s12879-024-10079-8
Jia-Le Peng, Ke Xu, Ye Tong, Shi-Zhi Wang, Hao-Di Huang, Chang-Jun Bao, Qi-Gang Dai

Background: This study aimed to analyze the epidemic characteristics and influencing factors of school influenza outbreaks in Jiangsu Province, China from 2020 to 2023,following the COVID-19 pandemic, to inform prevention and control strategies.

Methods: Data on influenza-like illness(ILI) outbreaks from the Chinese Influenza Surveillance Information System and national-level influenza surveillance sentinel hospitals were analyzed. The temporal distribution, school type, virus strains, and outbreak scales were examined using descriptive statistics.

Results: From 2020 to 2023, 1142 influenza outbreaks occurred in schools, with primary schools(ages 6 to 12) accounting for 71.80%. Most large outbreaks were caused by A(H1N1) and A(H3N2), responsible for 8.99% of total outbreaks. Outbreaks were predominantly reported in the pre-peak periods of B(Victoria) and A(H1N1) circulation, accounting for 86.31% and 92.32% of their respective total outbreaks. No concurrent influenza and COVID-19 outbreaks were observed during the study period.

Conclusion: Primary and secondary schools are high-risk settings for influenza outbreaks. A(H3N2) shows higher adaptability and is more likely to co-circulate with other subtypes/lineages, especially A(H1N1), leading to larger outbreaks. B(Victoria)-caused outbreaks are more frequent but smaller in scale. School influenza outbreaks are more likely to occur during the early stages of seasonal peaks, particularly for B(Victoria) and A(H1N1). This suggests that influenza outbreaks in schools may play a crucial role in seeding and accelerating the spread of the virus within the broader community.

背景:本研究旨在分析COVID-19大流行后,江苏省2020-2023年学校流感暴发疫情的流行特征和影响因素,为防控策略提供参考:分析中国流感监测信息系统和国家级流感监测哨点医院的流感样病例数据。结果:从 2020 年到 2023 年,中国流感监测信息系统和国家级流感监测哨点医院共监测到 1111 例流感样病例:结果:2020-2023年间,学校共发生1142起流感暴发疫情,其中小学(6-12岁)占71.80%。大多数大规模疫情由甲型 H1N1 和甲型 H3N2 引起,占疫情总数的 8.99%。在乙型流感(维多利亚)和甲型流感(H1N1)流行的高峰前期,爆发的疫情居多,分别占疫情总数的 86.31% 和 92.32%。研究期间没有发现流感和 COVID-19 同时爆发的情况:结论:中小学是流感爆发的高危场所。结论:中小学是流感爆发的高危场所,甲型(H3N2)的适应性较强,更有可能与其他亚型/系别(尤其是甲型(H1N1))共同传播,从而导致更大规模的爆发。由乙型(维多利亚)流感引起的爆发更频繁,但规模较小。在季节性流感高峰初期,学校更容易爆发流感,尤其是乙型(维多利亚)和甲型(H1N1)流感。这表明,流感在学校爆发可能在更广泛的社区内播种和加速病毒传播方面发挥关键作用。
{"title":"Epidemiological characteristics of influenza outbreaks in schools in Jiangsu Province, China, 2020-2023 post-COVID-19 pandemic.","authors":"Jia-Le Peng, Ke Xu, Ye Tong, Shi-Zhi Wang, Hao-Di Huang, Chang-Jun Bao, Qi-Gang Dai","doi":"10.1186/s12879-024-10079-8","DOIUrl":"https://doi.org/10.1186/s12879-024-10079-8","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to analyze the epidemic characteristics and influencing factors of school influenza outbreaks in Jiangsu Province, China from 2020 to 2023,following the COVID-19 pandemic, to inform prevention and control strategies.</p><p><strong>Methods: </strong>Data on influenza-like illness(ILI) outbreaks from the Chinese Influenza Surveillance Information System and national-level influenza surveillance sentinel hospitals were analyzed. The temporal distribution, school type, virus strains, and outbreak scales were examined using descriptive statistics.</p><p><strong>Results: </strong>From 2020 to 2023, 1142 influenza outbreaks occurred in schools, with primary schools(ages 6 to 12) accounting for 71.80%. Most large outbreaks were caused by A(H1N1) and A(H3N2), responsible for 8.99% of total outbreaks. Outbreaks were predominantly reported in the pre-peak periods of B(Victoria) and A(H1N1) circulation, accounting for 86.31% and 92.32% of their respective total outbreaks. No concurrent influenza and COVID-19 outbreaks were observed during the study period.</p><p><strong>Conclusion: </strong>Primary and secondary schools are high-risk settings for influenza outbreaks. A(H3N2) shows higher adaptability and is more likely to co-circulate with other subtypes/lineages, especially A(H1N1), leading to larger outbreaks. B(Victoria)-caused outbreaks are more frequent but smaller in scale. School influenza outbreaks are more likely to occur during the early stages of seasonal peaks, particularly for B(Victoria) and A(H1N1). This suggests that influenza outbreaks in schools may play a crucial role in seeding and accelerating the spread of the virus within the broader community.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Incidence of serious respiratory tract infections and associated characteristics in a population exposed to immunosuppressive therapies: a register-based population study. 在接受免疫抑制疗法的人群中,严重呼吸道感染的发病率及相关特征:一项基于登记的人口研究。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-21 DOI: 10.1186/s12879-024-10039-2
Cindy Etienne, Ana-Maria Vilcu, Flora Finet, Sylvain Chawki, Thierry Blanchon, Olivier Steichen, Thomas Hanslik

Background: Immunosuppressive therapies are associated with a risk of infections. Nevertheless, their incidence in this population remains unclear. This study aims to determine the incidence of serious respiratory tract infections (SRI) in a population exposed to immunosuppressive therapies.

Methods: Data from a representative sample of the French healthcare claims from 01/01/2014 to 12/31/2019 were analyzed. Exposure to immunosuppressive therapy was defined by the dispensation of drugs through community pharmacies or in hospitals. SRI diagnosis was based on ICD-10 codes from hospitalization records. A cohort analysis was performed to estimate standardized SRI incidence rates. A nested case-control analysis within this cohort was used to study the characteristics associated with SRI.

Results: We identified 24,122 individuals exposed to immunosuppressive therapies, among which 1,559 developed SRI, resulting in a standardized incidence rate of 1,398 per 100,000 person-years. In this population, the risk of SRI was associated with a history of cancer (OR 2.68, 95% Confidence Intervals (CI) 2.24-3.21; p < 0.001), chronic respiratory disease (2.62, 95%CI 2.17-3.16; p < 0.001), end-stage renal failure (2.38, 95%CI 1.37-4.13; p = 0.003), neurodegenerative diseases (1.52, 95%CI 1.07-2.17; p = 0.026), diabetes (1.44, 95%CI 1.14-1.82; p < 0.001), psychiatric diseases (1.27, 95%CI 1.06-1.52; p < 0.001), and cardiovascular diseases (1.26, 95%CI 1.04-1.52; p = 0.002). Compared to corticosteroids alone, the risk of SRI was lower in individuals treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) only (0.44, 95%CI 0.25-0.78; p < 0.001).

Conclusion: In the population exposed to immunosuppressive therapies, a history of chronic disease is associated with an increased risk of SRI. This risk is lower in those receiving csDMARD alone than corticosteroids alone.

背景:免疫抑制疗法与感染风险有关。然而,这类人群的感染率仍不清楚。本研究旨在确定接受免疫抑制疗法人群中严重呼吸道感染(SRI)的发病率:方法:分析了2014年1月1日至2019年12月31日期间具有代表性的法国医疗索赔样本数据。接触免疫抑制疗法的定义是通过社区药房或医院配药。SRI 诊断基于住院记录中的 ICD-10 编码。通过队列分析估算标准化 SRI 发病率。在该队列中使用嵌套病例对照分析来研究与 SRI 相关的特征:我们确定了 24,122 名接受过免疫抑制疗法的患者,其中 1,559 人罹患 SRI,标准化发病率为每 10 万人年 1,398 例。在这一人群中,SRI 的发病风险与癌症病史相关(OR 2.68,95% 置信区间 (CI) 2.24-3.21;P 结论:SRI 的发病风险与癌症病史相关(OR 2.68,95% 置信区间 (CI) 2.24-3.21;P 结论):在接受免疫抑制疗法的人群中,慢性病史与 SRI 风险增加有关。与单独使用皮质类固醇相比,单独使用 csDMARD 的患者的这一风险较低。
{"title":"Incidence of serious respiratory tract infections and associated characteristics in a population exposed to immunosuppressive therapies: a register-based population study.","authors":"Cindy Etienne, Ana-Maria Vilcu, Flora Finet, Sylvain Chawki, Thierry Blanchon, Olivier Steichen, Thomas Hanslik","doi":"10.1186/s12879-024-10039-2","DOIUrl":"10.1186/s12879-024-10039-2","url":null,"abstract":"<p><strong>Background: </strong>Immunosuppressive therapies are associated with a risk of infections. Nevertheless, their incidence in this population remains unclear. This study aims to determine the incidence of serious respiratory tract infections (SRI) in a population exposed to immunosuppressive therapies.</p><p><strong>Methods: </strong>Data from a representative sample of the French healthcare claims from 01/01/2014 to 12/31/2019 were analyzed. Exposure to immunosuppressive therapy was defined by the dispensation of drugs through community pharmacies or in hospitals. SRI diagnosis was based on ICD-10 codes from hospitalization records. A cohort analysis was performed to estimate standardized SRI incidence rates. A nested case-control analysis within this cohort was used to study the characteristics associated with SRI.</p><p><strong>Results: </strong>We identified 24,122 individuals exposed to immunosuppressive therapies, among which 1,559 developed SRI, resulting in a standardized incidence rate of 1,398 per 100,000 person-years. In this population, the risk of SRI was associated with a history of cancer (OR 2.68, 95% Confidence Intervals (CI) 2.24-3.21; p < 0.001), chronic respiratory disease (2.62, 95%CI 2.17-3.16; p < 0.001), end-stage renal failure (2.38, 95%CI 1.37-4.13; p = 0.003), neurodegenerative diseases (1.52, 95%CI 1.07-2.17; p = 0.026), diabetes (1.44, 95%CI 1.14-1.82; p < 0.001), psychiatric diseases (1.27, 95%CI 1.06-1.52; p < 0.001), and cardiovascular diseases (1.26, 95%CI 1.04-1.52; p = 0.002). Compared to corticosteroids alone, the risk of SRI was lower in individuals treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) only (0.44, 95%CI 0.25-0.78; p < 0.001).</p><p><strong>Conclusion: </strong>In the population exposed to immunosuppressive therapies, a history of chronic disease is associated with an increased risk of SRI. This risk is lower in those receiving csDMARD alone than corticosteroids alone.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Critical resistance to carbapenem and aminoglycosides in Pseudomonas aeruginosa: spread of blaNDM/16S methylase armA harboring isolates with intrinsic resistance mechanisms in Kerman, Iran. 铜绿假单胞菌对碳青霉烯类和氨基糖苷类药物的临界耐药性:伊朗克尔曼地区具有内在耐药机制的 blaNDM/16S 甲基化酶 armA 携带分离物的传播。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-21 DOI: 10.1186/s12879-024-10085-w
Behnaz Soltani, Roya Ahmadrajabi, Davood Kalantar-Neyestanaki

Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is one of the main Gram-negative bacterium causes of infections in hospital settings, and the spread of them is a significant challenge to public health.

Methods: A total of 30 non-duplicate isolates of CRPA were collected. Antibacterial susceptibility of isolates to antibiotic agents, AmpC β-lactamase production, and biofilm formation were determined. Minimum biofilm inhibitory concentrations (MBIC) of isolates to cefepime (FEP), imipenem (IPM), ceftazidime (CAZ), and meropenem (MEM) were evaluated with/without cloxacillin (CLX). The carbapenemase and 16 S rRNA methylase genes were identified by PCR, and the transcription levels of oprD, ampC, and mexA genes were determined by quantitative real-time PCR (qPCR). ERIC-PCR was used to detect genetic relationships among isolates.

Results: All isolates were multidrug resistant (MDR) and strong biofilm producers. The resistance genes including blaNDM, blaIMP, blaVIM, blaSIM, blaGES, and armA were detected in 21 (70%), 6 (20%), 3 (10%), 2 (6.6%), 1 (3.3%), and 17 (56.6%) of the isolates, respectively. CLX at 500 and 1000 µg/mL significantly reduced the level of MIC to MEM, IPM, CAZ, and FEP, also at 2000 µg/mL significantly reduced the level of MBIC to MEM, IPM, CAZ, and FEP. In all isolates, the transcription levels of oprD were significantly downregulated as well as significantly increased for ampC and mexA. ERIC-PCR typing results divided 30 isolates into four clusters A to D.

Conclusion: In this study, we reported the spread of different clones of CRPA harboring co-existence of various carbapenemase genes with armA 16 S rRNA methylase for the first time in Kerman, Iran. Also, our isolates had several mechanisms of resistance to carbapenems as well as ability biofilm formation along with resistance to aminoglycosides, the further spread of which could cause serious challenges in our hospital settings. Therefore, serious monitoring is necessary to reduce their prevalence.

背景:耐碳青霉烯类铜绿假单胞菌(CRPA)是导致医院感染的主要革兰氏阴性菌之一,其传播是公共卫生面临的重大挑战:方法:共收集了 30 份非重复的 CRPA 分离物。方法:共收集了 30 个非重复的 CRPA 分离物,测定了分离物对抗生素的敏感性、AmpC β-内酰胺酶的产生和生物膜的形成。在使用/不使用氯唑西林(CLX)的情况下,评估了分离菌对头孢吡肟(FEP)、亚胺培南(IPM)、头孢他啶(CAZ)和美罗培南(MEM)的最低生物膜抑制浓度(MBIC)。通过 PCR 鉴定碳青霉烯酶和 16 S rRNA 甲基化酶基因,并通过定量实时 PCR(qPCR)测定 oprD、ampC 和 mexA 基因的转录水平。ERIC-PCR用于检测分离株之间的遗传关系:结果:所有分离株都具有多重耐药性(MDR),并具有很强的生物膜产生能力。在 21 个(70%)、6 个(20%)、3 个(10%)、2 个(6.6%)、1 个(3.3%)和 17 个(56.6%)分离株中分别检测到了 blaNDM、blaIMP、blaVIM、blaSIM、blaGES 和 armA 等耐药基因。浓度为 500 和 1000 µg/mL 的 CLX 能显著降低 MEM、IPM、CAZ 和 FEP 的 MIC 水平,浓度为 2000 µg/mL 的 CLX 也能显著降低 MEM、IPM、CAZ 和 FEP 的 MBIC 水平。在所有分离物中,oprD 的转录水平明显下调,而 ampC 和 mexA 的转录水平则明显升高。ERIC-PCR分型结果将30个分离株分为A至D四个群组:在这项研究中,我们首次报告了伊朗克尔曼地区不同克隆的 CRPA 的传播情况,这些克隆携带多种碳青霉烯酶基因和 armA 16 S rRNA 甲基化酶。此外,我们分离出的菌株对碳青霉烯类有多种耐药机制,具有形成生物膜的能力,同时对氨基糖苷类药物也有耐药性,这些菌株的进一步扩散可能会给我们的医院环境带来严峻挑战。因此,有必要对其进行认真监测,以降低其流行率。
{"title":"Critical resistance to carbapenem and aminoglycosides in Pseudomonas aeruginosa: spread of bla<sub>NDM</sub>/16S methylase armA harboring isolates with intrinsic resistance mechanisms in Kerman, Iran.","authors":"Behnaz Soltani, Roya Ahmadrajabi, Davood Kalantar-Neyestanaki","doi":"10.1186/s12879-024-10085-w","DOIUrl":"10.1186/s12879-024-10085-w","url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is one of the main Gram-negative bacterium causes of infections in hospital settings, and the spread of them is a significant challenge to public health.</p><p><strong>Methods: </strong>A total of 30 non-duplicate isolates of CRPA were collected. Antibacterial susceptibility of isolates to antibiotic agents, AmpC β-lactamase production, and biofilm formation were determined. Minimum biofilm inhibitory concentrations (MBIC) of isolates to cefepime (FEP), imipenem (IPM), ceftazidime (CAZ), and meropenem (MEM) were evaluated with/without cloxacillin (CLX). The carbapenemase and 16 S rRNA methylase genes were identified by PCR, and the transcription levels of oprD, ampC, and mexA genes were determined by quantitative real-time PCR (qPCR). ERIC-PCR was used to detect genetic relationships among isolates.</p><p><strong>Results: </strong>All isolates were multidrug resistant (MDR) and strong biofilm producers. The resistance genes including bla<sub>NDM</sub>, bla<sub>IMP</sub>, bla<sub>VIM</sub>, bla<sub>SIM</sub>, bla<sub>GES,</sub> and armA were detected in 21 (70%), 6 (20%), 3 (10%), 2 (6.6%), 1 (3.3%), and 17 (56.6%) of the isolates, respectively. CLX at 500 and 1000 µg/mL significantly reduced the level of MIC to MEM, IPM, CAZ, and FEP, also at 2000 µg/mL significantly reduced the level of MBIC to MEM, IPM, CAZ, and FEP. In all isolates, the transcription levels of oprD were significantly downregulated as well as significantly increased for ampC and mexA. ERIC-PCR typing results divided 30 isolates into four clusters A to D.</p><p><strong>Conclusion: </strong>In this study, we reported the spread of different clones of CRPA harboring co-existence of various carbapenemase genes with armA 16 S rRNA methylase for the first time in Kerman, Iran. Also, our isolates had several mechanisms of resistance to carbapenems as well as ability biofilm formation along with resistance to aminoglycosides, the further spread of which could cause serious challenges in our hospital settings. Therefore, serious monitoring is necessary to reduce their prevalence.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of 10-valent pneumococcal conjugate vaccine on trends of pneumococcal meningitis in children under five years, Uganda, 2003-2022. 10 价肺炎球菌结合疫苗对乌干达五岁以下儿童肺炎球菌脑膜炎趋势的影响,2003-2022 年。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-21 DOI: 10.1186/s12879-024-10075-y
Yasiini Nuwamanya, Immaculate Ampeire, Michael Baganizi, Ritah Atugonza, Fred Nsubuga, Benon Kwesiga, Richard Migisha, Lilian Bulage, Daniel Kadobera, Alex Riolexus Ario, Annet Kisakye

Background: Pneumococcal meningitis, a vaccine-preventable disease caused by Streptococcus pneumoniae (Spn) is the leading bacterial meningitis in under five children. In April 2014, Uganda introduced routine immunization with 10-valent Pneumococcal Conjugate Vaccine (PCV10) for infants. The target coverage for herd immunity is ≥ 90% with three doses (PCV10-dose 3). We assessed the effect of PCV10 introduction and coverage on the trends of pneumococcal meningitis in under five children.

Methods: We analyzed laboratory-confirmed pediatric bacterial meningitis (PBM) data at two high-volume WHO-accredited sentinel surveillance hospitals in Kampala City and Gulu District, from 2003 to 2022. We used confirmed cases to estimate the minimum incidence of pneumococcal meningitis in the host districts and calculated annual incidence of pneumococcal meningitis per one million populations, and the proportion of confirmed PBM attributable to Spn. We divided the study period into 2003-2013 (pre-PCV10) and 2014-2022 (post-PCV10), and conducted interrupted time series analysis using autoregressive integrated moving average models for the effect of PCV10 on trends of pneumococcal meningitis and PBM attributable to Spn. We analyzed reported PCV10 data in DHIS2 from 2014 to 2022 for annual PCV10-dose 3 coverage.

Results: Among the 534 confirmed PBM cases, 331(62%) were pneumococcal meningitis; 227(69%) from Gulu District and 104(31%) from Kampala City. The majority (95%) of the isolates were not serotyped. The majority (57%) were male and unimmunized (98%); median age = 14(IQR = 6-27) months with most (55%) aged ≥ 12 months. The case-fatality rate was 9%. During Pre-PCV10 period, the overall incidence of pneumococcal meningitis in the host districts increased; slope change = 1.0 (95%CI = 0.99999, 1.00001) but declined in post-PCV10 period (2014-2022) by 92% from 86 cases /1,000,000 in 2014 to 7/1,000,000 in 2022, slope change= -1.00006 (95%CI=-1.00033, -0.99979). Whereas there was an immediate decline in the proportion of confirmed PBM attributable to Spn in the host districts, level change=-1.84611(95%CI=-1.98365,-1.70856), an upward trend was recorded from 2016 to 2022, slope change = 1.0 (95%CI = 0.99997, 1.00003). During 2015-2022, PCV10-dose 3 coverage was largely > 90% for Gulu District and 52-72% for Kampala City.

Conclusion: The PCV10 routine immunization program reduced the incidence of pneumococcal meningitis in Kampala City and Gulu District. There was no effect on the confirmed PBM proportionately attributable to Spn. Kampala City persistently recorded PCV10-dose3 coverage < 90%. We recommend enhancing serotyping and periodic nasopharyngeal carriage surveys to ascertain the maximum vaccine effectiveness and monitor Spn serotypes, and strengthening routine immunization in Kampala City.

背景:肺炎链球菌脑膜炎是一种可通过疫苗预防的疾病,由肺炎链球菌(Spn)引起,是五岁以下儿童中最主要的细菌性脑膜炎。2014 年 4 月,乌干达开始为婴儿常规接种 10 价肺炎球菌结合疫苗(PCV10)。群体免疫的目标覆盖率为≥90%,共接种3剂(PCV10-第3剂)。我们评估了 PCV10 的引入和覆盖率对五岁以下儿童肺炎球菌脑膜炎发病趋势的影响:我们分析了 2003 年至 2022 年期间坎帕拉市和古卢区两家世界卫生组织认可的高流量定点监测医院实验室确诊的小儿细菌性脑膜炎 (PBM) 数据。我们利用确诊病例来估算所在地区肺炎球菌脑膜炎的最低发病率,并计算出每百万人口中肺炎球菌脑膜炎的年发病率以及可归因于 Spn 的确诊肺炎球菌脑膜炎比例。我们将研究期间分为 2003-2013 年(PCV10 前)和 2014-2022 年(PCV10 后),并使用自回归综合移动平均模型进行了间断时间序列分析,以了解 PCV10 对肺炎球菌脑膜炎趋势和 Spn 引起的 PBM 的影响。我们分析了 DHIS2 中从 2014 年到 2022 年每年 PCV10 第 3 剂覆盖率的 PCV10 报告数据:在534例确诊的PBM病例中,331例(62%)为肺炎球菌脑膜炎;227例(69%)来自古卢区,104例(31%)来自坎帕拉市。大多数分离株(95%)未进行血清分型。大多数(57%)为男性,未接受免疫接种(98%);中位年龄=14(IQR=6-27)个月,大多数(55%)年龄≥12个月。病死率为 9%。在PCV10前期,东道区肺炎球菌脑膜炎的总体发病率有所上升;斜率变化=1.0(95%CI=0.99999,1.00001),但在PCV10后期(2014-2022年),发病率下降了92%,从2014年的86例/100万降至2022年的7例/100万,斜率变化=-1.00006(95%CI=-1.00033,-0.99979)。虽然宿主区确诊的 Spn PBM 比例立即下降,斜率变化=-1.84611(95%CI=-1.98365,-1.70856),但从 2016 年到 2022 年呈上升趋势,斜率变化=1.0(95%CI=0.99997,1.00003)。在 2015-2022 年期间,古卢区 PCV10 第三剂的覆盖率基本大于 90%,坎帕拉市为 52-72%:PCV10常规免疫计划降低了坎帕拉市和古卢区的肺炎球菌脑膜炎发病率。但对确诊的肺炎球菌性脑膜炎发病率没有影响。坎帕拉市持续保持 PCV10 剂量3覆盖率
{"title":"Effect of 10-valent pneumococcal conjugate vaccine on trends of pneumococcal meningitis in children under five years, Uganda, 2003-2022.","authors":"Yasiini Nuwamanya, Immaculate Ampeire, Michael Baganizi, Ritah Atugonza, Fred Nsubuga, Benon Kwesiga, Richard Migisha, Lilian Bulage, Daniel Kadobera, Alex Riolexus Ario, Annet Kisakye","doi":"10.1186/s12879-024-10075-y","DOIUrl":"10.1186/s12879-024-10075-y","url":null,"abstract":"<p><strong>Background: </strong>Pneumococcal meningitis, a vaccine-preventable disease caused by Streptococcus pneumoniae (Spn) is the leading bacterial meningitis in under five children. In April 2014, Uganda introduced routine immunization with 10-valent Pneumococcal Conjugate Vaccine (PCV10) for infants. The target coverage for herd immunity is ≥ 90% with three doses (PCV10-dose 3). We assessed the effect of PCV10 introduction and coverage on the trends of pneumococcal meningitis in under five children.</p><p><strong>Methods: </strong>We analyzed laboratory-confirmed pediatric bacterial meningitis (PBM) data at two high-volume WHO-accredited sentinel surveillance hospitals in Kampala City and Gulu District, from 2003 to 2022. We used confirmed cases to estimate the minimum incidence of pneumococcal meningitis in the host districts and calculated annual incidence of pneumococcal meningitis per one million populations, and the proportion of confirmed PBM attributable to Spn. We divided the study period into 2003-2013 (pre-PCV10) and 2014-2022 (post-PCV10), and conducted interrupted time series analysis using autoregressive integrated moving average models for the effect of PCV10 on trends of pneumococcal meningitis and PBM attributable to Spn. We analyzed reported PCV10 data in DHIS2 from 2014 to 2022 for annual PCV10-dose 3 coverage.</p><p><strong>Results: </strong>Among the 534 confirmed PBM cases, 331(62%) were pneumococcal meningitis; 227(69%) from Gulu District and 104(31%) from Kampala City. The majority (95%) of the isolates were not serotyped. The majority (57%) were male and unimmunized (98%); median age = 14(IQR = 6-27) months with most (55%) aged ≥ 12 months. The case-fatality rate was 9%. During Pre-PCV10 period, the overall incidence of pneumococcal meningitis in the host districts increased; slope change = 1.0 (95%CI = 0.99999, 1.00001) but declined in post-PCV10 period (2014-2022) by 92% from 86 cases /1,000,000 in 2014 to 7/1,000,000 in 2022, slope change= -1.00006 (95%CI=-1.00033, -0.99979). Whereas there was an immediate decline in the proportion of confirmed PBM attributable to Spn in the host districts, level change=-1.84611(95%CI=-1.98365,-1.70856), an upward trend was recorded from 2016 to 2022, slope change = 1.0 (95%CI = 0.99997, 1.00003). During 2015-2022, PCV10-dose 3 coverage was largely > 90% for Gulu District and 52-72% for Kampala City.</p><p><strong>Conclusion: </strong>The PCV10 routine immunization program reduced the incidence of pneumococcal meningitis in Kampala City and Gulu District. There was no effect on the confirmed PBM proportionately attributable to Spn. Kampala City persistently recorded PCV10-dose3 coverage < 90%. We recommend enhancing serotyping and periodic nasopharyngeal carriage surveys to ascertain the maximum vaccine effectiveness and monitor Spn serotypes, and strengthening routine immunization in Kampala City.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predicting the effect of nosocomial infection prevention on neonatal mortality and hospital stay in Ethiopia: a prospective longitudinal study. 预测埃塞俄比亚预防院内感染对新生儿死亡率和住院时间的影响:一项前瞻性纵向研究。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-21 DOI: 10.1186/s12879-024-10069-w
Etagegn Shacho, Argaw Ambelu, Ayele Taye Goshu, Daniel Yilma

Background: Neonatal Nosocomial infections (NNIs) are a significant cause of morbidity and mortality for neonates in an intensive care unit. Neonatal causes of death in healthcare facilities are attributed to different factors. We aimed to investigate factors associated with NNIs, estimate the burden of NNIs, and assess how the prediction effects help to save medical mortality and length of hospital stay.

Method: A prospective longitudinal study was conducted and data were collected from January 2022 to June 2022 from Jimma University Medical Center (JUMC). The data were gathered in a variety of ways, including an in-person interview with the patient's caregiver, direct observations of neonatal patients, and a review of the study participants' charts. This study includes patients aged 3 to 28 days who were admitted to the JUMC neonatal ward and stayed for at least 48 h. Multi-state model formulation and multivariate logistic regression were used for data analysis.

Results: A total of 545 neonates were included out of 688, and 30% (n = 164) of them acquired nosocomial infections (NIs); 98 (33%) of infected patients were born prematurely; and 71 (31.4%) were underweight at birth. NIs were higher in neonates with long hospital stay (AOR: 1.16, 95%CI: 1.13-1.20), use of urinary catheters (AOR: 3.09, 95%CI: 1.55-6.15), and undergoing surgical procedures (AOR: 2.42, 95%CI: 1.13-5.17). Patients who developed NIs had a higher risk of death (HR: 2, 95% CI: 1.31, 3.04). The burden of neonatal NIs was determined to have a risk of 0.3, a mortality rate of 9.6%, and an average duration of hospital stay of 14.6 days. Competing risk regression suggests that neonates with NIs have a significantly higher risk of death than those who are not infected (HR: 16.42, 95% CI: 8.70-30.98, p < 0.001). Assumed prevention that decreases the NIs rate in half would result in 101 lives and 1357 patient days saved from 10,000 neonatal inpatients.

Conclusion: Urinary catheterization and surgical procedure increased neonatal NIs. Longer hospital stay can increase the risk of NIs and can also result from the NIs. Our finding indicated that effective prevention of NIs could help reduce neonatal deaths and their hospital stays.

背景:新生儿院内感染(NNIs)是重症监护病房新生儿发病和死亡的重要原因。医疗机构中新生儿死亡的原因各不相同。我们的目的是调查与 NNIs 相关的因素,估计 NNIs 的负担,并评估预测效果如何有助于节省医疗死亡率和住院时间:我们开展了一项前瞻性纵向研究,从 2022 年 1 月至 2022 年 6 月收集了吉马大学医疗中心(JUMC)的数据。收集数据的方式多种多样,包括与患者的护理人员当面访谈、直接观察新生儿患者以及查看研究参与者的病历。研究对象包括入住 JUMC 新生儿病房且住院至少 48 小时的 3 至 28 天的患者。研究采用多态模型表述和多元逻辑回归进行数据分析:结果:688名新生儿中共有545名,其中30%(n = 164)感染了院内感染(NIs);98名(33%)感染者为早产儿;71名(31.4%)出生时体重不足。住院时间长(AOR:1.16,95%CI:1.13-1.20)、使用导尿管(AOR:3.09,95%CI:1.55-6.15)和接受外科手术(AOR:2.42,95%CI:1.13-5.17)的新生儿感染率较高。出现 NIs 的患者死亡风险较高(HR:2,95% CI:1.31,3.04)。新生儿 NIs 的负担风险为 0.3,死亡率为 9.6%,平均住院时间为 14.6 天。竞争风险回归表明,患有 NIs 的新生儿的死亡风险明显高于未感染 NIs 的新生儿(HR:16.42,95% CI:8.70-30.98,P 结论:导尿和外科手术增加了新生儿NIs。较长的住院时间会增加发生 NIs 的风险,也可能导致 NIs。我们的研究结果表明,有效预防 NIs 有助于减少新生儿死亡及其住院时间。
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引用次数: 0
Left hand abscess as a paradoxical reaction during treatment of disseminated tuberculosis in immunocompetent patient: case report and review of literature. 免疫功能正常患者在治疗播散性肺结核期间出现的矛盾反应--左手脓肿:病例报告和文献综述。
IF 3.4 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-10-21 DOI: 10.1186/s12879-024-10077-w
Aisha Alharbi, Aseel Aljahdali, Mohamed Firoze Ahamed, Hassan Almarhabi

A paradoxical reaction (PR) during the treatment of tuberculosis was defined as the worsening of preexisting disease either clinically or radiologically or the appearance of a new tuberculous lesion. These reactions are frequently observed in patients coinfected with human immunodeficiency virus (HIV) upon the initiation of antiretroviral therapy (ART). Herein, we present a unique case of a paradoxical reaction in a previously healthy 19-year-old female who started anti-tuberculosis treatment for disseminated tuberculosis. Four weeks after treatment initiation, she developed two new swollen masses in her left dorsum of the hand, accompanied by fever and new right submandibular painful lymphadenopathy, with worsening of the preexisting left lower neck lymph node. The patient underwent needle aspiration from her new skin abscess on the dorsum of her left hand, which revealed positive polymerase chain reaction (PCR) for Mycobacterium tuberculosis. Anti-tuberculosis treatment was continued, and the patient fully recovered. We described an unusual presentation of paradoxical reaction manifested by a skin abscess at a site distant from her primary disease in an immunocompetent TB patient, which demonstrated the importance of considering paradoxical reactions in HIV-negative patients who present with worsening signs and symptoms after initial improvement following treatment initiation.

结核病治疗过程中的矛盾反应(PR)是指临床或放射学上原有疾病恶化或出现新的结核病灶。合并感染人类免疫缺陷病毒(HIV)的患者在开始接受抗逆转录病毒疗法(ART)时经常会出现此类反应。在此,我们介绍一例独特的矛盾反应病例,患者是一名 19 岁女性,之前身体健康,因播散性肺结核开始接受抗结核治疗。治疗开始四周后,她的左手背出现了两个新的肿块,同时伴有发热和新的右下颌下腺痛性淋巴结病,原有的左下颈淋巴结也有所恶化。患者接受了左手背新出现的皮肤脓肿针吸术,结果显示结核分枝杆菌聚合酶链反应(PCR)呈阳性。继续进行抗结核治疗后,患者完全康复。我们描述了一名免疫功能正常的肺结核患者在远离原发疾病的部位出现皮肤脓肿的异常反应表现,这表明,对于在开始治疗后症状和体征初步改善后又出现恶化的艾滋病毒阴性患者,考虑异常反应非常重要。
{"title":"Left hand abscess as a paradoxical reaction during treatment of disseminated tuberculosis in immunocompetent patient: case report and review of literature.","authors":"Aisha Alharbi, Aseel Aljahdali, Mohamed Firoze Ahamed, Hassan Almarhabi","doi":"10.1186/s12879-024-10077-w","DOIUrl":"10.1186/s12879-024-10077-w","url":null,"abstract":"<p><p>A paradoxical reaction (PR) during the treatment of tuberculosis was defined as the worsening of preexisting disease either clinically or radiologically or the appearance of a new tuberculous lesion. These reactions are frequently observed in patients coinfected with human immunodeficiency virus (HIV) upon the initiation of antiretroviral therapy (ART). Herein, we present a unique case of a paradoxical reaction in a previously healthy 19-year-old female who started anti-tuberculosis treatment for disseminated tuberculosis. Four weeks after treatment initiation, she developed two new swollen masses in her left dorsum of the hand, accompanied by fever and new right submandibular painful lymphadenopathy, with worsening of the preexisting left lower neck lymph node. The patient underwent needle aspiration from her new skin abscess on the dorsum of her left hand, which revealed positive polymerase chain reaction (PCR) for Mycobacterium tuberculosis. Anti-tuberculosis treatment was continued, and the patient fully recovered. We described an unusual presentation of paradoxical reaction manifested by a skin abscess at a site distant from her primary disease in an immunocompetent TB patient, which demonstrated the importance of considering paradoxical reactions in HIV-negative patients who present with worsening signs and symptoms after initial improvement following treatment initiation.</p>","PeriodicalId":8981,"journal":{"name":"BMC Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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