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Samuel W Spaul, Ruth Hudson, Catherine Harvey, Helen Macdonald, Jesus Perez
In 2013 the UK Department of Health commissioned an independent Confidential Inquiry into the premature deaths of people with learning disabilities.1 In response, the Learning Disabilities Mortality Review (LeDeR) programme, the first of its kind globally, was carried out by the Healthcare Quality Improvement Partnership on behalf of the UK National Health Service. The LeDeR programme had two aims: to improve the quality of health and social care, and to reduce premature mortality and health inequalities for people with learning disabilities.
Yoshinori Taniguchi, Hirofumi Nishikawa, Nagamasa Maeda, Yoshio Terada
A 51-year-old woman attended our hospital with a 3-week history of worsening shortness of breath. She had no other physical complaints. She had a history of rheumatoid arthritis, which was in remission. On physical examination she was breathless and had an increased respiratory rate. We found no signs of joint disease, sclerodactyly, skin eruption, or pretibial oedema. Arterial blood gas gave an oxygen saturation of 92% on room air. A chest x-ray showed large bilateral pleural effusions (figure).
Alison P Galvani, Alyssa S Parpia, Eric M Foster, Burton H Singer, Meagan C Fitzpatrick
Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017).
Hélène Mascitti, Ruxandra Calin, Aurélien Dinh, Sabrina Makhloufi, Benjamin Davido
Toscana virus (TOSV) belongs to the arthropod-borne virus. It is a common cause of meningitis or meningo-encephalitis in Mediterranean area, typically reported in Southern Europe (Cusi et al., 2010) (see Fig. 1). In the literature, numerous TOSV meningitis have been described, including complicated neurological disorders (Sanbonmatsu-Gámez et al., 2009; Baldelli et al., 2004). Only rare publications reported extra-meningeal involvement (Charrel et al., 2005), particularly two cases which reported a testicle pain (Baldelli et al., 2004; Zanelli et al., 2013).
Xiaosong Song, Lan Wen, Maolin Li, Xinyuan Yu, Lijun Wang, Kunyi Li
This study aimed to determine the characteristics and risk factors of adult new-onset seizure patients with tuberculous meningitis (TBM) during long-term follow-up.
Qinqin Yan, Shuyi Yang, Jie Shen, Shuihua Lu, Fei Shan, Yuxin Shi
Z. Du et al.
Hyeri Seok, Juhyun Song, Ji Hoon Jeon, Hee Kyoung Choi, Won Suk Choi, Sungwoo Moon, Dae Won Park
We evaluated the effect of timing and appropriateness of antibiotics administration on mortality in patients diagnosed with sepsis according to the Sepsis-3 definition.
Henan Xin, Xuefang Cao, Haoran Zhang, Jianmin Liu, Shouguo Pan, Xiangwei Li, Ling Guan, Fei Shen, Zisen Liu, Dakuan Wang, Xueling Guan, Jiaoxia Yan, Hengjing Li, Boxuan Feng, Mingxia Zhang, Qianting Yang, Qi Jin, Lei Gao, for the LATENTTB-NSTM study team
Using QuantiFERON-TB Gold In-Tube (QFT-GIT) for monitoring tuberculosis (TB) and latent TB infection (LTBI) treatment effect is controversial. The present study aims to evaluate the dynamic changes of interferon gamma (IFN-γ) levels along with LTBI treatment based on a randomized controlled study.
Marcellin F, Miailhes P, Santos M, et al.
Wiesenfeld H, Meyn L, Darville T, et al.
AbstractBackgroundAnaerobic organisms are important pathogens in acute pelvic inflammatory disease (PID). The currently recommended PID regimen of a single dose of ceftriaxone and doxycycline for 14 days has limited anaerobic activity. The need for broader anaerobic coverage is unknown and concerns have been raised about metronidazole tolerability.MethodsWe conducted a randomized, double-blind placebo-controlled trial comparing ceftriaxone 250 mg IM single dose and doxycycline for 14 days, with or without 14 days of metronidazole in women with acute PID. The primary outcome was clinical improvement at 3 days following enrollment. Additional outcomes at 30 days following treatment were the presence of anaerobic organisms in the endometrium, clinical cure (absence of fever and reduction in tenderness), adherence and tolerability.ResultsWe enrolled 233 women (116 to metronidazole and 117 to placebo). Clinical improvement at 3 days was similar between the two groups. At 30 days following treatment, anaerobic organisms were less frequently recovered from the endometrium in women treated with metronidazole than placebo (8% vs 21%, p
Loh K, Zhong Y, Lin L, et al.
Satlin M, Lewis J, II, Weinstein M, et al.
AbstractRecent data on polymyxin pharmacokinetics (PK), pharmacodynamics (PD), toxicity and clinical outcomes suggest these agents have limited clinical utility. PK-PD data show a steady state concentration of 2 ug/mL is required for killing bacteria with colistin minimum inhibitory concentrations (MICs) of 2 ug/mL. Less than 50% of patients with normal renal function achieve this exposure and it is associated with high risk of nephrotoxicity. This exposure does not achieve bacterial stasis in pneumonia models. Randomized and observational studies consistently demonstrate increased mortality for polymyxins compared to alternative agents. CLSI and EUCAST are two global organizations that establish interpretive criteria for in vitro susceptibility data. CLSI has recently taken the step to eliminate the “susceptible” interpretive category for the polymyxins, whereas EUCAST maintains this interpretive category. This viewpoint describes the opinions of the two organizations and the data that were used to inform their perspectives.
McCreery R, Cawcutt K, Cortes-Penfield N, et al.
To the Editor—Johnson, Brown, and Priest recently reported a randomized, open-label study of oral vancomycin prophylaxis (OVP) for hospitalized patients at elevated risk of healthcare facility–onset (HCFO) Clostridioides difficile infection (CDI) . Randomizing 106 such patients to receive either OVP or no prophylaxis for the duration of systemic antibiotic therapy plus an additional 5 days, the authors reported that OVP reduced the frequency of HCFO-CDI (0% vs 12% among the 100 evaluated patients; P = .03). They conclude that “once-daily oral vancomycin was a clinically efficacious, well-tolerated, cost-effective option for patients at risk for developing HCFO-CDI while hospitalized.”
Scrub typhus is an acute febrile illness caused by the obligate intracellular bacterium, Orientia tsutsugamushi. Immunochromatography (ICT) and IgM ELISA are two of the routinely employed antibody based assays for diagnosis of Scrub typhus fever in Nepal, although the recommended gold standard diagnostic test is IgM Immunofluorescence assay (IFA). This study evaluated InBios Scrub Typhus Detect™ Immunoglobulin M (IgM) ELISA and IgM Immunofluorescence assays in single serum sample at the time of admission.
Study participants (1585 suspected cases), were enrolled based on acute febrile illness with suspected scrub typhus cases in central Nepal. Blood sample was collected from the suspected patients of scrub typhus, presenting with acute febrile illness. IgM antibody to Orientia tsusugamushi was detected by using Scrub Typhus Detect™ Kit and an in-house IgM IFA. The IFA assay was performed with the Gilliam, Karp, Kato strains and O. chuto antigens following the ARRL protocol.
Statistical analysis of IgM ELISA results when compared to reference test, IgM IFA results demonstrated the following characteristics, sensitivity 84.0% (95%CI: 79.73–87.68%), specificity 94.82% (95% CI: 93.43–95.99%), positive likelihood ratio 16.21% (95% CI: 12.71–20.67%), negative likelihood ratio 0.17% (95% CI: 0.13–0.21%), disease prevalence 22.08% (95% CI: 20.06 -24.21%), positive predictive value 82.12% (95% CI: 78.28–85.42%) and negative predictive value 95.44% (95% CI: 94.27–96.38%) respectively.
Although IgM IFA is considered the gold standard test for the diagnosis of scrub typhus cases, it is relatively expensive, requires trained personal and a microscope with fluorescence filters. Scrub typhus IgM ELISA may be the best alternative test and possible viable option for resource limited endemic countries like Nepal.
Currently, Staphylococcus aureus is one of the most important pathogens worldwide, especially for methicillin-resistant S. aureus (MRSA) infection. However, few reports referred to patients’ MRSA infections in Yunnan province, southwest China.
In this study, we selected representative MRSA strains from patients’ systemic surveillance in Yunnan province of China, performed the genomic sequencing and compared their features, together with some food derived strains.
Among sixty selective isolates, forty strains were isolated from patients, and twenty isolated from food. Among the patients’ strains, sixteen were recognized as community-acquired (CA), compared with 24 for hospital-acquired (HA). ST6-t701, ST59-t437 and ST239-t030 were the three major genotype profiles. ST6-t701 was predominated in food strains, while ST59-t437 and ST239-t030 were the primary clones in patients. The clinical features between CA and HA-MRSA of patients were statistical different. Compared the antibiotic resistant results between patients and food indicated that higher antibiotic resistant rates were found in patients’ strains. Totally, the average genome sizes of 60 isolates were 2.79 ± 0.05 Mbp, with GC content 33% and 84.50 ± 0.20% of coding rate. The core genomes of these isolates were 1593 genes. Phylogenetic analysis based on pan-genome and SNP of strains showed that five clustering groups were generated. Clustering ST239-t030 contained all the HA-MRSA cases in this study; clustering ST6-t701 referred to food and CA-MRSA infections in community; clustering ST59-t437 showed the heterogeneity for provoking different clinical diseases in both community and hospital. Phylogenetic tree, incorporating 24 isolates from different regions, indicated ST239-t030 strains in this study were more closely related to T0131 isolate from Tianjin, China, belonged to ‘Turkish clade’ from Eastern Europe; two groups of ST59-t437 clones of MRSA in Yunnan province were generated, belonged to the ‘Asian-Pacific’ clone (AP) and ‘Taiwan’ clone (TW) respectively.
ST239-t030, ST59-t437 and ST6-t701 were the three major MRSA clones in Yunnan province of China. ST239-t030 clonal Yunnan isolates demonstrated the local endemic of clone establishment for a number of years, whereas ST59-t437 strains revealed the multi-origins of this clone. In general, genomic study on epidemic clones of MRSA in southwest China provided the features and evolution of this pathogen.
In 1987, Gillies and Coetzee published a pictorial key for the morphological identification of adult female mosquitoes. Since then, several new species of anopheline mosquitoes have been described.
The 1987 key to adult female mosquitoes was used as the template for the current key.
New species described in the literature over the past 32 years have been included. A list of all currently known Afrotropical species is provided. Anopheles stephensi is included for the first time as occurring on the African continent.
An updated key for the morphological identification of Afrotropical anopheline species is presented.
To describe the burden, and characteristics, of influenza-like illness (ILI) associated with non-influenza respiratory viruses (NIRV).
We performed a prospective, multicenter, observational study of adults admitted with ILI during three influenza seasons (2012–2015). Patients were screened for picornavirus, respiratory syncytial virus (RSV), coronavirus, human metapneumovirus, adenovirus, bocavirus, parainfluenza virus, and influenza, by PCR on nasopharyngeal samples. We excluded patients coinfected with NIRV and influenza.
Among 1421 patients enrolled, influenza virus was detected in 535 (38%), and NIRV in 215 (15%), mostly picornavirus (n = 61), RSV (n = 53), coronavirus 229E (n = 48), and human metapneumovirus (n = 40). In-hospital mortality was 5% (NIRV), 4% (influenza), and 5% (no respiratory virus). As compared to influenza, NIRV were associated with age (median, 73 years vs. 68, P = 0.026), chronic respiratory diseases (53% vs. 45%, P = 0.034), cancer (14% vs. 9%, P = 0.029), and immunosuppressive drugs (21% vs. 14%, P = 0.028), and inversely associated with diabetes (18% vs. 25%, P = 0.038). On multivariable analysis, only chronic respiratory diseases (OR 1.5 [1.1–2.0], P = 0.008), and diabetes (OR 0.5 [0.4–0.8], P = 0.01) were associated with NIRV detection.
NIRV are common in adults admitted with ILI during influenza seasons. Outcomes are similar in patients with NIRV, influenza, or no respiratory virus.
Bailin S, McGinnis K, McDonnell W, et al.
AbstractBackgroundA higher proportion of circulating memory CD4+ T cells is associated with prevalent diabetes mellitus in the general population. Given the broad changes in adaptive immunity, including memory T cell expansion, and rising prevalence of diabetes in the HIV population, we assessed whether similar relationships were present in persons with HIV (PWH).MethodsMultiple CD4+ and CD8+ T cell subsets were measured by flow cytometry and prevalent diabetes cases were adjudicated by two physicians for PWH and HIV-negative participants in the Veterans Aging Cohort Study. Multivariable logistic regression models evaluated the association of T cell subsets and diabetes stratified by HIV status, adjusted for cytomegalovirus serostatus and traditional risk factors.ResultsAmong 2385 participants (65% PWH, 95% male, 68% African American), higher CD45RO+ memory CD4+ T cells and lower CD38+ CD4+ T cells were associated with prevalent diabetes, and had a similar effect size, in both the PWH and HIV-negative (p
Murenzi G, Kanyabwisha F, Murangwa A, et al.
AbstractBackgroundWe examined the trend of the prevalence of high-risk human papillomavirus (hrHPV) cervical infection among Rwandan women living with HIV (WLWH) over a period of 12 years.MethodsThe prevalence of cervical hrHPV DNA was measured in three different studies conducted at three different time periods in three different groups of WLWH using three different but comparable hrHPV tests: a MY09/MY11 PCR test in 2005 (RWISA) (n=497), careHPV in 2009-2010 (HPV Demonstration) (n=1,242), and Xpert HPV Test in 2016-2018 (U54) (n=4,734). Prevalences were also adjusted for age groups and CD4 cell count categories.ResultsHrHPV prevalence decreased over time from 42.5% to 32.2% to 26.5%, respectively (p
Ali Khalid, Alicia Fajardo Lubián, Li Ma, Ruby CY Lin, Jonathan R. Iredell
Nan-Yu Chen, Shu-Wei Kao, Zhuo-Hao Liu, Ting-Shu Wu, Chia-Lung Tsai, Hsi-Hsun Lin, Wing-Wai Wong, Yea-Yuan Chang, Shu-Sheng Chen, Stephane Wen-Wei Ku
Diana Mutuku Mulatya, Caroline Ochieng
M. P. Parikh et al.
Coffey C, Collier S, Gleason M, et al.
AbstractBackgroundGiardiasis is the most common intestinal parasitic disease of humans identified in the United States and an important waterborne disease. In the United States, giardiasis has been variably reportable since 1992 and was made a nationally notifiable disease in 2002. Our objective was to describe the epidemiology of US giardiasis cases from 1995–2016 using National Notifiable Disease Surveillance System data.MethodsNegative binomial regression models were used to compare incidence rates by age groups (0–4, 5–9, 10–19, 20–29, 30–39, 40–49, 50–64 and ≥65 years) during three time periods (1995–2001, 2002–2010 and 2011–2016).ResultsFrom 1995–2016, the average number of reported cases were 19 781 per year (range 14 623–27 778 cases). The annual incidence of reported giardiasis in the US decreased across all age groups. This decrease differs by age group and sex and may reflect either changes in surveillance methods (for example changes to case definitions or reporting practices) or changes in exposure. Incidence rates in males and older age groups did not decrease to the same extent as rates in females and children.ConclusionsTrends suggest that differences in exposures by sex and age group are important to the epidemiology of giardiasis. Further investigation into the risk factors of populations with higher rates of giardiasis will support prevention and control efforts.
Rhoads J, Willson T, Sutton J, et al.
AbstractBackgroundMost skin and soft tissue infections (SSTIs) are managed in the outpatient setting, but data are lacking on treatment patterns outside the emergency department (ED). Available data suggest there is poor adherence to SSTI treatment guidelines.MethodsWe conducted a retrospective cohort study of Veterans diagnosed with SSTIs in the ED or outpatient clinics from 1/1/2005–6/30/2018. The incidence of SSTIs over time was modeled using Poisson regression using robust standard errors. Antibiotic selection and incision and drainage (I&D) were described and compared between ambulatory settings. Anti-methicillin-resistant Staphylococcus aureus (MRSA) antibiotic use was compared to SSTI treatment guidelines.ResultsThere were 1,740,992 incident SSTIs in 1,156,725 patients during the study period. The incidence of SSTIs significantly decreased from 4.58 in 2005 to 3.27 per 1,000 patient-years in 2018 (p
Ogoina D, Iroezindu M, James H, et al.
AbstractIn a retrospective review of hospital records of 40 human monkeypox from Nigeria, majority developed fever and self-limiting vesiculopustular skin eruptions. Five deaths were reported. Compared to HIV-negative cases, HIV-1-coinfected cases had more prolonged illness, larger size lesions and higher rates of both secondary bacterial skin infections and genital ulcers.
Pouwels K, , Vansteelandt S, et al.
AbstractBackgroundStudies estimating excess length of stay (LoS) attributable to nosocomial infections have failed to address time-varying confounding, likely leading to overestimation of their impact. We present a methodology based on inverse probability-weighted (IPW) survival curves to address this limitation.MethodsA case-study focusing on intensive care unit-acquired bacteraemia using data from two general ICUs from two London teaching hospitals were used to illustrate the methodology. The area under the curve (AUC) of a conventional Kaplan Meier curve applied to the observed data was compared with that of an IPW Kaplan Meier curve applied after treating bacteraemia as censoring events. Weights were based on the daily probability of acquiring bacteraemia. The difference between the observed average LoS and the average LoS that would be observed if all bacteraemia cases could be prevented was multiplied by the number of admitted patients to obtain the total excess LoS.ResultThe estimated total number of extra ICU days caused by 666 bacteraemia cases were estimated at 2453 (95% CI 1803 – 3103) days. The excess number of days were overestimated when ignoring time-varying confounding (2845, 95% CI 2276 – 3415) or when completely ignoring confounding (2838, 95% CI 2101 – 3575).ConclusionICU-acquired bacteraemia was associated with a substantial excess LoS. Wider adoption of IPW survival curves or alternative techniques that address time-varying confounding could lead to better informed decision making around nosocomial infections and other time-dependent exposures.
Krassenburg L, Zanjir W, Georgie F, et al.
AbstractBackgroundThe causal link of sustained virological response (SVR) with outcome has been challenged. With markedly improved SVR rates with direct-acting antivirals (DAAs), the benefit of SVR would be expected to diminish if the association with outcome is not causal.MethodsData were collected for patients starting treatment with interferon (IFN) or DAAs between June 2006 and December 2016. To control for disease severity, patients were IFN-eligible (IDEAL) based on criteria for the IDEAL peginterferon trial. Clinical events were decompensation, hepatocellular carcinoma, liver transplantation and all-cause mortality.ResultsIn 1078 IDEAL-eligible patients, 1306 treatments occurred; 52% IFN, 49% DAAs. Cirrhosis was present in 30% DAAs vs. 21% IFN (P
Passerine birds are frequently infected with diverse haemosporidian parasites. While infections are traditionally considered benign in wild birds, recent studies demonstrated mortalities of passerine species due to exo-erythrocytic development of the parasites, which can damage organs in affected hosts. However, exo-erythrocytic development remains insufficiently investigated for most haemosporidian species and thus little is known about the virulence of tissue stages in wild passerine birds. The aim of the present study was to investigate natural haemosporidian infections in deceased Eurasian blackbirds (Turdus merula) and song thrushes (Turdus philomelos) and to determine parasite burden and associated histological effects.
For molecular analysis, blood and tissue samples from 306 thrushes were screened for Plasmodium, Haemoproteus and Leucocytozoon parasites by nested PCR. For the detection of parasite stages in organ samples, tissue sections were subjected to chromogenic in situ hybridization (CISH) using genus- and species-specific probes targeting the rRNAs of parasites. Exo-erythrocytic parasite burden was semi-quantitatively assessed and histological lesions were evaluated in haematoxylin–eosin-stained sections.
By PCR, 179 of 277 Eurasian blackbirds and 15 of 29 song thrushes were positive for haemosporidians. Parasites of all three genera were detected, with Plasmodium matutinum LINN1 and Plasmodium vaughani SYAT05 showing the highest prevalence. CISH revealed significant differences in exo-erythrocytic parasite burden between lineages in Eurasian blackbirds, with P. matutinum LINN1 frequently causing high exo-erythrocytic parasite burdens in various organs that were associated with histological alterations. Song thrushes infected with P. matutinum LINN1 and birds infected with other haemosporidian lineages showed mostly low exo-erythrocytic parasite burdens. Two Eurasian blackbirds infected with Leucocytozoon sp. TUMER01 showed megalomeronts in various organs that were associated with inflammatory reactions and necroses.
This study suggests that P. matutinum LINN1, a common lineage among native thrushes, regularly causes high exo-erythrocytic parasite burdens in Eurasian blackbirds, which may result in disease and mortalities, indicating its high pathogenic potential. The findings further illustrate that the same parasite lineage may show different levels of virulence in related bird species which should be considered when assessing the pathogenicity of haemosporidian parasite species. Finally, the study provides evidence of virulent Leucocytozoon sp. TUMER01 infections in two Eurasian blackbirds caused by megalomeront formation.
Mehrotra A, D’Angelo J, Romney-Vanterpool A, et al.
AbstractIFN-α can suppress production of T cell polarizing cytokines or induce inhibitory antigen presenting cells that suppress T cell activation. Previous studies showed that IFN-α therapy fails to boost virus-specific T cell immunity in patients with chronic Hepatitis B virus (HBV) infection. Our aim was to determine whether IFN-α exposure alters human antigen presenting cell function in vivo. We investigated the immunomodulatory effects using healthy donor PBMC exposed to IFN-α, and chronic hepatitis B (CHB) patients starting IFN-α therapy. IFN-α increased HLA-DR, CD80, CD86 and PD-L1 expression on healthy donor monocytes. In contrast to the activated phenotype, IFN-α inhibited TLR-induced cytokine production and monocyte-induced T cell proliferation. In CHB patients, peg-IFN treatment induced an interferon-stimulated gene signature in monocytes and increased HLA-DR, CD80, CD86 and PD-L1 expression. As early as 3d after CHB patients started treatment, IFN-α inhibited monocyte cytokine production and T cell stimulation ex vivo. IFN-α-mediated inhibition of IL-12 production, rather than inhibitory receptor expression, was responsible for inhibition of T cell proliferation. Addition of IL-12 restored T cell proliferation to baseline levels. Understanding how professional antigen presenting cells respond to immunomodulation is important for both new innate and adaptive-targeted immunotherapies.
Due to an increasing incidence of invasive fungal infections, the availability of reliable diagnostic tools for the fast detection of a wide spectrum of fungal pathogens is of vital importance. In this study, we aimed to conduct an extensive clinical evaluation of a recently published in-house panfungal PCR assay on samples from suspected invasive fungal infections.
Overall 265 clinical samples from 232 patients with suspected invasive fungal disease (96 deep airway samples, 60 sterile fluids, 50 tissue biopsies, and 59 blood samples) were included. All samples underwent standard culture-based diagnostics and were additionally analyzed with our panfungal PCR assay.
Overall, 55.1% of agreement between culture and the panfungal PCR was observed; in 17% of all samples partial concordance was noted, while results between culture and our PCR assay were not in agreement in 27.9%. Our panfungal assay performed better in samples from normally sterile sites, while samples from the deep airways yielded the highest rate of discordant (39.6%) results. In two tissue and three blood samples an invasive pathogen was only detected by PCR while cultures remained negative.
In combination with routine methods, our panfungal PCR assay is a valuable diagnostic tool. Patients at risk for invasive fungal infections might profit from the reduced time to pathogen identification.
The aim of this study was to analyse temporal changes in the epidemiology of candidemia assessing patient’s characteristics, risk factors, diagnostic management, treatment, and outcome in a tertiary care hospital in South Eastern Germany.
In this retrospective cohort study patients with blood cultures positive for Candida spp. were identified from the microbiological database in the years 2006–2018. A detailed collection of patients’ characteristics was obtained for the time periods 2006–2008 and 2016–2018. Risk factors for survival were analysed in a logistic regression analysis.
In the years 2006–2018, a total of 465 episodes of candidemia were identified. An increase in candidemia cases was evident in the period of 2016–2018 compared to 2006–2015 and to 2006–2008 in absolute numbers and adjusted to patient-days. C. albicans was responsible for 62.8% of cases in 2006–2008 and 51.2% of all cases in the years 2016–2018, respectively, whereas there was a significant increase of C. glabrata in the latter period (16.3–31.5%). Overall mortality was not significantly different in the two periods. Infectious diseases consultation led to a lower mortality of patients with candidemia and to a higher adherence to guidelines. In multivariate analysis, only complete change or extraction of intravascular indwelling material and female gender were independent predictors for survival.
We observed an increase in candidemia rates and rates of non-albicans spp. over time. A complete change of all catheters and/or indwelling devices improved survival. ID consultation led to a better guideline adherence.
B. Melot et al.
Piret, J., Boivin, G.
Herpes simplex virus 1 (HSV-1) can be responsible for life-threatening HSV encephalitis (HSE). The mortality rate of patients with HSE who do not receive antiviral treatment is 70%, with most survivors suffering from permanent neurological sequelae. The use of intravenous acyclovir together with improved diagnostic technologies such as PCR and magnetic resonance imaging has resulted in a reduction in the mortality rate to close to 20%. However, 70% of surviving patients still do not recover complete neurological functions. Thus, there is an urgent need to develop more effective treatments for a better clinical outcome. It is well recognized that cerebral damage resulting from HSE is caused by viral replication together with an overzealous inflammatory response. Both of these processes constitute potential targets for the development of innovative therapies against HSE. In this review, we discuss recent progress in therapy that may be used to ameliorate the outcome of patients with HSE, with a particular emphasis on immunomodulatory agents. Ideally, the administration of adjunctive immunomodulatory drugs should be initiated during the rise of the inflammatory response, and its duration should be limited in time to reduce undesired effects. This critical time frame should be optimized by the identification of reliable biomarkers of inflammation.
After publication of the original article , we were notified that units of testosterone in main text and abstract and units of DHEA-S in Fig. 1 and Table 4 are incorrect.
Salmonellosis remains an important public health problem globally. The disease is among the leading causes of morbidity and mortality in developing countries that experience poor hygiene and lack of access to clean and safe water. There was an increase in reported cases of Salmonellosis in Njombe Region, Southern Highland of Tanzania between 2015 and 2016 based on clinical diagnosis. Nevertheless, little is known about the factors contributing to the transmission of this disease in the region. This study was conducted to determine the prevalence, antimicrobial susceptibility, and factors associated with Salmonella infection among patients who report gastrointestinal complaints.
A cross-sectional study was conducted from December 2017 to February 2018 among patients with gastrointestinal complaints at Kibena Regional Hospital. Stool samples were submitted for isolation of Salmonella spp. Identification was based on conventional biochemical tests and serotyping to differentiate typhoid and non-typhoid Salmonella (NTS). Antimicrobial susceptibility was performed using the Kirby-Bauer disc diffusion method. Multivariable logistic regression analysis was performed to examine the factors independently associated with Salmonella infection.
The prevalence of Salmonella infection among participants with gastrointestinal complaints was 16.5% (95% CI: 12.7–21.1) of them, 83.7, 95% CI: 70.9–91.5 were NTS while 16.3, 95% CI: 8.5–29.0 were Typhoid Salmonella species.
All isolates were sensitive to ceftriaxone and ciprofloxacin, whereas 27.8 and 100% were resistant to co-trimoxazole and ampicillin respectively. The odd of Salmonella infection was fourfold higher among participants with formal employment (AOR 3.8, 95% CI, 1.53–9.40). Use of water from wells/rivers (AOR 2.2, 95% CI, 1.07–4.45), drinking untreated water (AOR 2.6, 95% CI, 1.21–5.48) and often eating at a restaurant (AOR 3.4, 95% CI, 1.28–8.93) had increased odds of Salmonella infection. Likewise, having abdominal pain (AOR 8.5, 95% CI, 1.81–39.78) and diarrhea (AOR 2.3, 95% CI, 1.12–4.68) were independent symptoms that predict Salmonella infection.
There is a high prevalence of Salmonella infection among people who report gastrointestinal complaints and it is clinically predicated by diarhoea and abdominal pain. Employed participants and those eating at restaurant and drinking unsafe water had higher risk of infection. Salmonella spp. causing gastroenteritis has developed resistance to commonly used antibiotics.
Vertebral osteomyelitis can be attributed to many factors including immunosuppression, diabetes, malignancy, collagen disease, periodontal disease, open fractures, and endoscopic procedures. Anaerobic bacteria, such as Veillonella species, are found in the oral cavity and are rarely implicated in the infection. This report describes vertebral osteomyelitis secondary to a dental abscess with positive Veillonella cultures.
A 76-year-old man presented to the hospital due to back pain with a four-day history of fever and chills. CT scans revealed several abscesses in the lumbar region as well as indications of vertebral osteomyelitis. After a psoas drain, the patient began antibiotics with a combination of ampicillin-sulbactam, metronidazole, and levofloxacin, but due to the patient’s penicillin allergy, he was initially desensitized to this antibiotic for a significant period of time. Laminectomies, foraminotomies, and facetectomies were performed, but the infection spread to vertebral levels. The patient was then switched to a combination of vancomycin, metronidazole, and levofloxacin which eliminated the infection. Final laminectomy was performed with posterior segmental instrumentation and arthrodesis. Post-operatively, there were no signs of infection. The patient recovered well and regained mobility. Deeper examination of the patient’s medical history revealed a severe tooth abscess immediately before the onset of bacteremia.
We believe that a delay in the onset of antibiotic treatment is what led to the initial bacteremia that ultimately took root in the lower lumbar vertebrae. To the best of our ability, we could identify only one other case that linked vertebral osteomyelitis to the oral cavity.
Tuberculosis (TB) remains a major cause of avoidable deaths. Economic migrants represent a vulnerable population due to their exposure to medical and social risk factors. These factors expose them to higher risks for TB incidence and poor treatment outcomes.
This cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient’s government-defined residency status with treatment success and loss to follow-up categories at baseline and performed a comparative interrupted time series (ITS) analysis to assess the impact of community-based adherence support on treatment outcomes. Key measures of interest of the ITS were the differences in step change (β6) and post-intervention trend (β7).
Short-term, inter-province migrants experienced lower treatment success (aRR = 0.95 [95% CI: 0.92–0.99], p = 0.010) and higher loss to follow-up (aOR = 1.98 [95% CI: 1.44–2.72], p 55 years of age (aRR = 0.93 [95% CI: 0.89–0.96], p
Extrapulmonary tuberculosis (EPTB) poses diagnostic challenges due to the paucibacillary nature of the disease. The immunochemistry-based MPT64 antigen detection test (MPT64 test) has shown promising results for diagnosing EPTB in previous studies performed in low-resource settings, with higher sensitivity than microscopy and culture. The aim of this study was to investigate the performance of the MPT64 test in a routine clinical setting in a high-income low TB prevalence country.
Extrapulmonary samples sent for TB diagnostics to microbiology and pathology laboratories at three regional tertiary care hospitals in Norway in a one-year period were included and subjected to the MPT64 test in parallel to the routine TB diagnostic tests.
Samples from 288 patients were included and categorised as confirmed TB cases (n = 26), clinically diagnosed TB cases (n = 5), non-TB cases (n = 243) and uncategorised (n = 14), using a composite reference standard (CRS). In formalin-fixed biopsies, the sensitivity (95% CI) of the MPT64 test, microscopy, PCR-based tests pooled, and culture was 37% (16–62), 20% (4–48), 37% (16–62) and 50% (23–77), respectively, against the CRS. The MPT64 test showed a good positive predictive value (88%) and an excellent specificity (99, 95% CI 92–100) in formalin-fixed biopsies. In fine-needle aspirates, pus and fluid samples, the test performance was lower.
The MPT64 test was implementable in pathology laboratories as part of routine diagnostics, and although the sensitivity of the MPT64 test was not better than culture in this setting, the test supplements other rapid diagnostic methods, including microscopy and PCR-based tests, and can contribute to strengthen the diagnosis of EPTB in formalin-fixed biopsies in the absence of culture confirmation.
Community–acquired pneumonia (CAP) is one of the leading worldwide causes of childhood morbidity and mortality. Its disease burden varies by age and etiology and is time dependent. We aimed to investigate the annual and seasonal patterns in etiologies of pediatric CAP requiring hospitalization.
We conducted a retrospective study in 30,994 children (aged 0–18 years) with CAP between 2010 and 2015 at 23 nationwide hospitals in South Korea. Mycoplasma pneumoniae (MP) pneumonia was clinically classified as macrolide-sensitive MP, macrolide-less effective MP (MLEP), and macrolide-refractory MP (MRMP) based on fever duration after initiation of macrolide treatment, regardless of the results of in vitro macrolide sensitivity tests.
MP and respiratory syncytial virus (RSV) were the two most commonly identified pathogens of CAP. With the two epidemics of MP pneumonia (2011 and 2015), the rates of clinical MLEP and MRMP pneumonia showed increasing trends of 36.4% of the total MP pneumonia. In children
Cho, Kyung-Jae; Kwon, Oyeon; Kwon, Joon-myoung; Lee, Yeha; Park, Hyunho; Jeon, Ki-Hyun; Kim, Kyung-Hee; Park, Jinsik; Oh, Byung-Hee
As the performance of a conventional track and trigger system in a rapid response system has been unsatisfactory, we developed and implemented an artificial intelligence for predicting in-hospital cardiac arrest, denoted the deep learning-based early warning system. The purpose of this study was to compare the performance of an artificial intelligence-based early warning system with that of conventional methods in a real hospital situation.
Retrospective cohort study.
This study was conducted at a hospital in which deep learning-based early warning system was implemented.
We reviewed the records of adult patients who were admitted to the general ward of our hospital from April 2018 to March 2019.
The study population included 8,039 adult patients. A total 83 events of deterioration occurred during the study period. The outcome was events of deterioration, defined as cardiac arrest and unexpected ICU admission. We defined a true alarm as an alarm occurring within 0.5–24 hours before a deteriorating event.
Measurements and Main Results:
We used the area under the receiver operating characteristic curve, area under the precision-recall curve, number needed to examine, and mean alarm count per day as comparative measures. The deep learning-based early warning system (area under the receiver operating characteristic curve, 0.865; area under the precision-recall curve, 0.066) outperformed the modified early warning score (area under the receiver operating characteristic curve, 0.682; area under the precision-recall curve, 0.010) and reduced the number needed to examine and mean alarm count per day by 69.2% and 59.6%, respectively. At the same specificity, deep learning-based early warning system had up to 257% higher sensitivity than conventional methods.
The developed artificial intelligence based on deep-learning, deep learning-based early warning system, accurately predicted deterioration of patients in a general ward and outperformed conventional methods. This study showed the potential and effectiveness of artificial intelligence in an rapid response system, which can be applied together with electronic health records. This will be a useful method to identify patients with deterioration and help with precise decision-making in daily practice.
Drs. Cho, O. Kwon, and J.-m. Kwon contributed equally to this study.
Drs. O. Kwon and H. Park disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: email@example.com
Copyright © by 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Takiguchi, Toru; Nakajima, Mikio; Ohbe, Hiroyuki; Sasabuchi, Yusuke; Matsui, Hiroki; Fushimi, Kiyohide; Kim, Shiei; Yokota, Hiroyuki; Yasunaga, Hideo
Previous studies have suggested that vasodilator therapy may be beneficial for patients with nonocclusive mesenteric ischemia. However, robust evidence supporting this contention is lacking. We examined the hypothesis that vasodilator therapy may be effective in patients diagnosed with nonocclusive mesenteric ischemia.
Retrospective cohort study.
The Japanese Diagnosis Procedure Combination inpatient database.
A total of 1,837 patients with nonocclusive mesenteric ischemia from July 2010 to March 2018.
Measurements and Main Results:
We compared patients who received vasodilator therapy (vasodilator group; n = 161) and those who did not (control group; n = 1,676) using one-to-four propensity score matching. Vasodilator therapy was defined as papaverine and/or prostaglandin E1 administered via venous and/or arterial routes within 2 days of admission. Only patients who did not receive abdominal surgery within 2 days of admission were analyzed. The main outcomes were in-hospital mortality and abdominal surgery performed greater than or equal to 3 days after admission. After propensity score matching, in-hospital mortality was significantly lower in the vasodilator group (risk difference, –11.6%; p = 0.005). The proportion of patients who received abdominal surgery at greater than or equal to 3 days after admission was also significantly lower in the vasodilator group (risk difference, –10.2%; p = 0.002).
Vasodilator therapy with papaverine and/or prostaglandin E1 is associated with lower in-hospital mortality and prevalence of abdominal surgery in patients with nonocclusive mesenteric ischemia.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Drs. Fushimi and Yasunaga received support from grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141). The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: firstname.lastname@example.org
Copyright © by 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
To K, Tsang O, Chik-Yan Yip C, et al.
AbstractThe 2019-novel-coronavirus (2019-nCoV) was detected in the self-collected saliva of 91.7% (11/12) of patients. Serial saliva viral load monitoring generally showed a declining trend. Live virus was detected in saliva by viral culture. Saliva is a promising non-invasive specimen for diagnosis, monitoring, and infection control in patients with 2019-nCoV infection.
Ronald P. de Vries, Miia R. Mäkelä
Plant biomass degradation by fungi is a widely studied and applied field of science, due to its relevance for the global carbon cycle and many biotechnological applications. Before the genome era, many of the in-depth studies focused on a relatively small number of species, whereas now, many species can be addressed in detail, revealing the large variety in the approach used by fungi to degrade plant biomass. This variation is found at many levels and includes genomic adaptation to the preferred biomass component, but also different approaches to degrade this component by diverse sets of activities encoded in the genome.
Nicky O’Boyle, Natasha C.A. Turner, Andrew J. Roe, James P.R. Connolly
Bacterial pathogens employ diverse fitness and virulence mechanisms to gain an advantage in competitive niches. These lifestyle-specific traits require integration into the regulatory network of the cell and are often controlled by pre-existing transcription factors. In this review, we highlight recent advances that have been made in characterizing this regulatory flexibility in prominent members of the Enterobacteriaceae. We focus on the direct global interactions between transcription factors and their target genes in pathogenic Escherichia coli and Salmonella revealed using chromatin immunoprecipitation coupled with next-generation sequencing.
Nature Medicine, Published online: 11 February 2020; doi:10.1038/s41591-020-0778-7Antibiotic tolerance leads to antibiotic resistance
International Congress on Infectious Diseases (ICID) 2020
Kuala Lumpur, Malaysia
20.02.2020 - 23.02.2020
Dansk Selskab for Intern Medicin (DSIM) årsmøde og overrækkelse af Hagedorn prisen 2020
Novo Nordisk Fonden, Tuborg Havnevej 19, 2900 Hellerup
Conference on Retroviruses and Opportunistic Infections (CROI) 2020
Boston, Massachusetts, USA
8.03.2020 - 11.03.2020
Når CROI går i fisk - med transmissioner fra CROI 2020
10.03.2020 - 11.03.2020
World TB day 2020
National handlingsplan for antibiotika til mennesker (2017)
Retningslinjer til sundhedsprofessionelle vedr. håndtering af infektion med zikavirus (2019)
Antiviral behandling af hiv smittede personer (2019)
Yield, Efficiency and Costs of Mass Screening Algorithms for Tuberculosis in Brazilian Prisons
17.02.2020Clinical Infectious Diseases Advance Access
Detecting Tuberculosis in Prisons: Switching Off the Disease at its Source
17.02.2020Clinical Infectious Diseases Advance Access
Effect of diabetes mellitus on short-term prognosis of 227 pyogenic liver abscess patients after hospitalization
17.02.2020Latest Results for BMC Infectious Diseases
Terlipressin Increases Systemic and Lowers Pulmonary Arterial Pressure in Experimental Acute Pulmonary Embolism
15.02.2020Critical Care Medicine - Online First
Sustained reduction in third-generation cephalosporin usage in adult inpatients following introduction of an antimicrobial stewardship program in a large urban hospital in Malawi
15.02.2020Clinical Infectious Diseases Advance Access
Hvorfor synes Professor Jens Lundgren, at du bør læse"Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV."?
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