GMS infectious diseases最新文献

Background: Genital tuberculosis (GTB) is a significant etiological factor of infertility in developing countries such as India; however, it is frequently undiagnosed due to its asymptomatic nature and a lack of standardised protocols. This study aimed to compare the diagnostic efficacy of GeneXpert (CBNAAT) with Ziehl-Neelsen (ZN) staining, Mycobacterial Growth Indicator Tube (MGIT) liquid culture and histopathological examination (HPE). Additionally, the occurrence of GTB in infertile women aged between 18 and 45 years was also determined.

Methods: The study comprised 200 infertile women with suspected GTB. Endometrial biopsy samples were collected aseptically and subjected to ZN staining, MGIT liquid culture, GeneXpert testing and HPE and the results were analysed and compared. MGIT was considered the gold standard test in accordance with National TB Elimination Programme (NTEP) recommendations.

Results: There were 164 (82%) cases of primary infertility, and 36 (18%) cases of secondary infertility. Out of the 200 samples of endometrial biopsy (EB) specimens, the GeneXpert test detected two positive findings (1%), ZN staining detected two positive results (1%), and MGIT liquid culture as well as HPE detected one positive result (0.5%). GeneXpert demonstrated a sensitivity of 100% (confidence interval (CI) 2.50-100.00%), a specificity of 99.5% (CI 97.23-99.99%), a positive predictive value (PPV) of 50% (CI 12.40-87.60%), and a negative predictive value (NPV) of 100% (CI 98.15-100.00%), with liquid culture as reference. A significant agreement was found between the diagnostic procedures of MGIT and GeneXpert, with a kappa value of 0.66 and a p-value of 0.047 (significant p-value <0.05).

Conclusion: The present study is among the few that has utilised GeneXpert to aid in the diagnosis of female genital tuberculosis (FGTB). GeneXpert, being much faster and more feasible than conventional methods such as culture, could be incorporated into the standard evaluation of GTB.

Foodborne campylobacteriosis is the most common cause of bacterial gastroenteritis in Germany. Due to increasing antibiotic resistance in Campylobacter, data of isolates of human origin are published by the European Center for Disease Control and Prevention (ECDC)/European Food Safety Authority (EFSA). However, data on susceptibility to meropenem, an antibiotic of last resort, is not included. Therefore, the minimal inhibitory concentration (MIC) for meropenem was measured in 125 Campylobacter jejuni (Cj) and 57 Campylobacter coli (Cc) isolates isolated from human stool samples between 2020 and 2023, comparing ellipsoid test and broth microdilution. Additionally, we determined the susceptibility of 249 Cj and 84 Cc strains isolated between 2018 and 2023 to erythromycin, ciprofloxacin and oxytetracycline by disk diffusion according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST). For meropenem, the MIC results of 5% Campylobacter isolates were interpreted as resistant. Erythromycin resistance was found in none Cj versus 9 (11%) Cc isolates that were resistant to all three substances. Ciprofloxacin and oxytetracycline resistance were detected in 72 and 41% Cj, and 67 and 70% Cc isolates, respectively. Only 24% Cj and 13% C c isolates were susceptible to all three substances. The dual resistance of ciprofloxacin and oxytetracycline was the most common resistance pattern, observed in 37% Cj and 38% Cc isolates, respectively. None of the isolates was resistant to all four tested substances. Our data underline the need for susceptibility testing of Campylobacter to alternatively used antimicrobial substances in clinical laboratories. The ellipsoid test provides a good alternative for meropenem MIC testing, although borderline isolates should be confirmed using microdilution.

Background: Acute upper respiratory tract infections (URTIs) are frequent causes of medical treatment by general practitioners (GPs). In general, these are viral and self-limiting illnesses, but antibiotics are prescribed. In Germany, fluoroquinolones are not authorised for the indications pharyngitis, laryngitis, tonsillitis and acute bronchitis due to possible serious side effects. This analysis looks at fluoroquinolone prescriptions for URTI by GPs in 2022.

Methods: Frequency of fluoroquinolone prescriptions were analysed at case level and regionally using administrative insurance data from the German health insurance company BARMER. We included patients treated in GP practices without relevant concomitant diseases.

Results: In 2022, 25% (1,197,568/4,720,786) of insured persons with upper respiratory tract infections (URTI) were prescribed antibiotics. After excluding comorbidities and other risk factors such as previous hospitalisation, the prescription rate for uncomplicated URTIs was calculated to be 6% (80,786/1,365,646). Fluoroquinolones were given in 2.4% of antibiotic prescriptions (1,951/80,786). Nationwide, 3.7% of the GPs prescribed fluoroquinolones, most frequently in the region Brandenburg with 6.6% (74/1,121).

Conclusion: This analysis showed that fluoroquinolones are still prescribed for uncomplicated URTI, which must be considered as alarming regarding the nature of the disease and the unfavourable risk-benefit profiles. There were clear regional differences in fluoroquinolone prescribing, indicating potential for improvement in the use of reserve antibiotics for uncomplicated upper respiratory tract infections.

While the majority of Trichosporon spp. isolated in clinical laboratories are typically associated with episodes of colonization or superficial infections, this fungal species has gained recognition as an opportunistic pathogen, leading to invasive infections worldwide. In this article, we present a case series of Trichosporon spp. identified through conventional methods, complemented by MALDI-TOF analysis from a reference institute for a single sample. The reported cases occurred within a confined time frame, and the construction of an epidemic curve suggested a common source with intermittent exposure. Despite the absence of identified breaches in infection prevention and control (IPC) in units with common exposure, this case series underscores the significance of considering Trichosporonosis in the differential diagnoses for post-transplant and chronic kidney disease patients, particularly those undergoing hemodialysis or utilizing Foley's catheter. Notably, research gaps were identified, emphasizing the need for further exploration of factors such as the role of magnesium and prolonged antibiotic usage in the development of invasive Trichosporon infections and newer treatment modalities against biofilm producing yeast like fungi.

The genus Fusarium, member of the Hypocreaceae family, comprises over 500 spp. with an ever-evolving taxonomy. These fungi, some highly pathogenic, primarily affect various plants, including major crops like maize, rice, cereals, and potatoes, leading to significant agricultural losses and contributing to human undernutrition in certain regions. Additionally, Fusarium spp. produce harmful mycotoxins like trichothecenes, fumonisins, zearalenones, etc., posing health risks to animals and humans. These toxins generally transferred to food items can cause diverse issues, including organ failure, cancer, and hormonal disturbances, with effects sometimes appearing years after exposure. The fungi's vast genetic repertoire enables them to produce a range of virulence factors, leading to infections in both animals and humans, particularly in immunocompromised individuals. Fusarium spp. can cause systemic infections and local infections like keratitis. Due to limited antifungal effectiveness and biofilm formation, these infections are often challenging to treat with poor outcomes.

Dermabacter hominis is a gram-positive facultative anaerobic agent. It is a human skin colonizer that can be responsible for opportunistic infections in immunocompromised patients. To date, the infections caused by this agent are related to bone, joint, eye, peritoneal dialysis catheters, abscesses or infected vascular grafts. Overall, it has a favorable outcome with good response to vancomycin, teicoplanin or linezolide, and so it has not been considered a concerning pathogenic agent. We present the first case in scientific literature with isolation of D. hominis in pericardial fluid in the setting of infectious bacterial pericarditis, with an aggressive course and poor evolution.

Background: Mortality is an important indicator for estimating the impact of the COVID-19 pandemic. However, different registrations provide different figures and the question is how to interpret the number of COVID-19 deaths reported.

Objective: To study the role of COVID-19 in dying in order to explain the representation of COVID-19 in cause-of-death statistics.

Methods: Analysis of all death certificates mentioning COVID-19 in the Dutch cause-of-death registry during the pandemic (n=51,181). The role of COVID-19 as cause of death was studied by the way it was reported on death certificates. A calculation of odds ratios was performed for studying associations between COVID-19 and other reported causes of death.

Results: In 24% of the cases COVID-19 was the only cause of death mentioned on a death certificate. In 76% of the cases, one or more other diseases played a role in dying. Three patterns emerged: COVID-19 associated with 1. neurodegenerative disorders, 2. chronic respiratory disorders, and 3. metabolic disorders. Of all death certificates mentioning the diseases, COVID-19 was the start of the causal chain leading to death in 45.2% of the cases, while COVID-19 was selected for cause-of-death statistics by special World Health Organization WHO instructions in 93.9% of the cases.

Conclusions: Cause-of-death statistics overestimate the role of COVID-19 as underlying cause of death. In a majority of the deceased cases, there is an association of COVID-19 with other diseases not captured by cause-of-death statistics reporting (only) one cause of death per deceased. A multi-causal approach is needed to evaluate the pandemic and inform health policy.

Uncomplicated cystitis is affecting many women of all ages and has a great impact on the quality of life, especially in women suffering from recurrent, uncomplicated cystitis. By far the most frequent uropathogen, E. coli, may have acquired increasing resistance against a variety of oral antibiotics, which may differ between countries and regions. Therefore, local resistance data are important to be considered. On the other hand, non-antibiotic therapy has also become an option which should be discussed and offered to the patient. In patients suffering from recurrent uncomplicated cystitis, individual risk factors and possible behavioral changes should first be taken into account. Non-antimicrobial prophylactic strategies shown to be successful in well-designed clinical studies are the next options. Long term antibiotic prophylaxis, however, should only be considered as a last option. For some of those patients self-diagnosis and self-treatment may be suitable, e.g. by using a recognized questionnaire.

Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome in which Coxiella burnetii is a very infrequent etiology. We present the case of a 62-year-old male with progressive pulmonary infiltrates, fever, hepatitis, and bicytopenia despite broad spectrum antibiotics. A thorough clinical evaluation led to a high suspicion of Coxiella burnetii infection, subsequently confirmed through a positive serum polymerase chain reaction (PCR) analysis. HLH diagnosis was established based on the fulfillment of 5/8 diagnostic criteria, obviating the need for a bone marrow biopsy. Targeted antibiotic treatment and dexamethasone led to full recovery within two weeks, eliminating the need for stronger immunosuppressive therapy.